The following is a transcript of
"WomenMatter, Facts and Trade-Offs Health CAre And Whose Job"
From October 15th, 2005



ANNOUNCER: WomenMatter Facts and Tradeoffs is brought to you by the Albert M. Greenfield Foundation.

WomenMatter, Facts and Trade-offs is the place where we can take one issue at a time, match what we do about it every day of our lives to the facts of the bigger system which we all live in, and recognize that every idea for making it better has trade-offs.

This show is about health care, and the very different ways some people think we might make it better. The debate over what would make it better is what makes it an issue. The two hosts of the show are Nancy Bauer, CEO and editor-in-chief of WomenMatter, and Susan Sargent, who has consulted nationally with health care consumers, providers, insurers and buyers for the past 30 years, and who currently works with a health care architecture and design firm. Nancy and Susan, welcome.

NANCY BAUER: Thanks a lot Victoria, good to be here. We women know exactly what works and what doesn’t. So WomenMatter focuses on health care because we’re in charge of health care where and when it actually happens. We’re so busy nagging our loved ones to eat right and drive safely, and taking our kids to the doctor, and of course, our mother-in-law to the hospital. And all of us married or not, help our elderly parents.

We don’t have a lot of time to study the system and make it better. So that’s why WomenMatter, Facts and Trade-offs puts what is known and what’s being argued about where we can easily get at it.

Where can you get at it? On the computer, or take it anywhere you want on your iPods. We can email it to our friends, and can discuss it with each other on the WomenMatter blog. And from this website we can tell our government representatives what we want them to do. Or you can choose a new one who will listen to what we know and what we want.

ANNOUNCER: Every issue, including this one about health care attached to jobs in the United States, meets up with the big questions. How much of this do I already handle on my own? How much do I want to handle on my own? What benefit is there to me if we take care of this as a larger community? And how might we use government, which if enough of us act together is us, to make the taxes we pay go to the standards of excellence we want?

BAUER: So first we need to brush up on the facts. What is the American health care system? And why is so much of it attached to somebody’s job? With the facts in hand, we can choose how each of us would like to make it better, and then each of us will have to decide for herself which trade-offs we’re willing to make.

SUSAN SARGENT: You know Nancy, I think it’s interesting that the trade-offs and the facts really are a troubling issue for most women, and actually for most consumers of health care. Because the time that you think you might need to see a doctor is usually very far away from when you actually show up and see a doctor or a nurse practitioner, because you’ve asked yourself just an awful lot of questions about, well who should I go to? What problem do I have? And how do I know that it’s worth going to see somebody especially, and who do I know is the best one? Do I know if they’re qualified? Do I know if they’ve hurt anybody? Do I know if my girlfriend recommends that they’re the best person to go to? So the quality of health care is an issue that we always have to deal with.

So let’s say we say, OK, I need to get care and I think this is the person who’s the best one that I can go to. That’s what I’ve heard. Well then, how do I know how long it’s going to take to get an appointment? If I think I have a problem today, how am I going to go and wait and if I’ve got kids, and they have to sit in the waiting room, or I have to pick up a family member after work, how do I know what the waiting time is going to be? Because they’re not going to tell me when I call to make the appointment that, by the way, you’re going to be sitting in the waiting room for two and a half hours.

And then, how do I know what my insurance pays for? Whether I’m on Medicaid or Medicare, or under a private insurance plan, sometimes they’re making the choices for me. They’ll decide who is on the panel. And while I’d love to think those are the best quality physicians and nurse practitioners and hospitals, sometimes they’re not. And sometimes they’ve just negotiated the best arrangement with the insurer.

And how do I know that the choice that I make is not only the best quality, but the best for me as a consumer? How do I know if they’re going to recommend surgery, when maybe I don’t need it?

And then that gets to the cost element, and that is if I go to the doctor who my girlfriend recommended, who probably has a low-waiting time, what’s it going to cost me? If I have a co-payment, well I’m not really sure how that works within my plan.

For example, I have what they call a cafeteria benefits plan, which means I can pay out cash and then my company will reimburse me, especially if it’s to prevent illness later on down the road.

And not only that, but what about parking? Do I have to park in a garage and pay for it? Or do I have to hire babysitters? Do I have to take time off from work? This is all part of the cost. And I need to know what technology, and whether that’s covered under my insurance.

And then going back to the waiting time, perhaps if I’m covered under Medicare or Medicaid, the doctor’s office might say, well we’ve decided not to accept any more Medicare or Medicaid patients.

BAUER: They could do that?

SARGENT: They really do. And on the providers’ side of the equation, Medicaid and Medicare pay a lot less for an office visit or for a procedure. So the doctors and the hospitals have to make a living as well. And so they have to kind of sit there and say well, I can only take this many people, I’m committing to providing care to as many people as I can. But I still have to make a living.

BAUER: That’s really interesting. So you’ve talked about the fact that we all want quality, and they always tell you to ask the doctor when you go there, how many of these have you done? Are you the best? I don’t know that anybody I know that has ever said, “Doctor, are you the best? How many of these have you done?” There I am, hoping that I’m going to be all right, so I’m in denial!

And this business of waiting time and choice. And we don’t even know what choices we have. And this business of being in the insurance pool with all sick people. And what if I got fat smokers in my group? What does that do to the costs?

SARGENT: Well some of the choices relative to cost have already been made for you. So you may not even have to make those choices. For example, if my son is playing soccer and he gets hurt and has to have an X-ray, and I take him to the nearest hospital. Actually they may say to me, well we can’t do it under that insurance plan because your insurance company has to have all the X-rays done by this other hospital across town, and that’s because they’ve negotiated a lower cost. And so some of the cost decisions are the consumer’s- are yours. And some of them are already made. And then you go back to the quality. Is it just cheaper, or is it better?

BAUER: Does everybody deal with this? Other countries and other places, everybody on the globe – what do we have in common? We’ve got life in common. And I trust that wherever we live and whatever language we speak, we all want to stay alive as long as we can, and we’d like to enjoy the best possible health.

But the world is divided up into nation states, and each one of those has a philosophy, and requires everyone living within it to follow it. So if we’re going to understand the facts and trade-offs that we have in this country and look at what the rest of the world let’s look at why, oh why, even every rich, developed country has a different system. Susan, are their philosophies all different? Or just the way they do it?

SARGENT: Well if you think about everyone who’s listening to this webcast, and how they look at health care, and multiply them times millions, and look at all the different countries. Every country has a different philosophy. And some of them believe, rightfully so, that it’s a government responsibility, either to ensure it, or insure some of the people who need a safety net or need coverage, such as the elderly or the very sick or the chronically sick. And some of them say, well no, it’s really an individual’s responsibility to take care of their health.

For example, in the U.S. there really is just now a movement towards having users of health care pay for more of it. So the co-pay is higher; that is, if you need to use the services, well you should be paying for it. Whereas in other countries they say no, we think it’s important for the government to pick up whatever is medically necessary. For example, Canada does that, and Japan does that. And they’ll say look, people have issues, it’s the government’s responsibility to take care of that and we will cover what’s medically necessary. Of course then the questions is, well what’s medically necessary?

BAUER: Who gets to decide what’s medically necessary? I’m the one with the problem.

SARGENT: Boy, it’s just a great question, because again, in all different countries, and even in our country, different people are deciding. We have many insurance companies who decide what is medically necessary to be covered under the insurance. So that if you go to seek, let’s say, psychiatric treatment or mental health treatment, some managed care companies or medical necessity companies will say well look, we don’t really think you need that right now, we’re not going to authorize payment on your insurance. And then you have to pay it out of pocket.

But going back to the other countries, some of them limit the overall costs of the plan. So for example, in Great Britain rather than saying we’ll only cover what’s medically necessary, they say we’ll pay for everything, but we can only do that for so long and then we can’t pay for certain technologies. And what’s happened is that by having a budget for health care for everybody, sometimes in Great Britain they get accused of rationing or determining who really can get this procedure and who can’t. Because maybe someone has got a lot of other medical complications and it may not make a difference in their health.

BAUER: Do they decide in Great Britain that if there is X amount of pounds in their system, the money in the system, that they’re going to divide it up so everybody gets sort of an equal piece of it? And that’s why people have to wait forever to get an operation or to see a doctor?

SARGENT: Unfortunately, and I’m sure there are statistics to back this up, and a lot of the details are actually on the website, www.womenmatter.com, in terms of what they do by country. And in some countries they get accused of saying, well no, if you’re 57 and you want to have this procedure, you’re probably going to live another 20 years and it’s not worth the return on investment for us to pay for that as it might be for someone who’s 37. So that you’ll have to wait a longer time to get the procedure.

And it’s also a function of how many providers are in your area. Even in our country, if you’re in Iowa, where there are 99 counties, many of those counties don’t have a sufficient set of physicians or hospitals, and then you have to travel a long distance. And so the waiting time and the access to health care services is going to be very different. Whereas in, let’s say Great Britain, where they actually employ the doctors, and they have a national health service—

BAUER: You mean the doctors work for the country? They work for the government?

SARGENT: The doctors and the hospitals. And actually that has worked well in some places, and in other places people are choosing to have private insurance. So it goes back and forth. But they will ensure that there are doctors out in the North Dakota parts of Great Britain, so that you can make sure that there are doctors around.

But then you run into the issues of technology. Now France, for example, has a similar investment in technology as the U.S. What’s interesting is that the U.S. spends almost twice what France does per person, per year. And that’s not the government. It’s if you added up all the health dollars and divided it by all of us, what are we spending per year? France is spending about half as much, and yet the World Health Organization said they were doing about a third better than we were, they were more highly ranked.

We spend a lot of money, and our doctors get paid more than anyone else actually, in the world, and yet we’re twentieth in infant mortality, and we’re twenty-ninth in having babies who weigh too little to be sustainable at birth.

BAUER: And that gets at the question of social class, and whether you’ve lucked out, whether you’re poor or rich, doesn’t it? The idea that according to our statistics, when they average things up, we also have the people who are the healthiest at certain ages because they have access to the best health care and the best doctors. Because you can buy it in this country. If you have enough money, and you know what you’re doing, you can go get it. But we have a sizeable group of poor people, an underclass of people, and where are they within our system anyhow? Lots of them I think do not even have access to health care at all, do they?

SARGENT: Well no they don’t. And a lot of them can go to federally funded health clinics or state funded health clinics, or city, municipally funded health clinics. But an issue that they deal with internationally is the poor, and everybody has a different approach. China, for example, which probably has more than all of the other countries added together, has to figure out how they’re going to get providers out there, and then how much people are going to pay.

China’s very interesting, because they require for every service that the patient pays something. It’s part of their individual responsibility.

BAUER: Even poor people.

SARGENT: Even poor people. And they also are required to have a certain contribution every year from their income. So if it’s six to eight percent of a million, and I’m sorry I don’t know the Chinese denomination, but if it’s a million yuan—

BAUER: Yuan.

SARGENT: Yuan, thank you. Then that’s a lot more that they’re contributing to the health care than someone who is fishing off the back of a boat. There’s a compulsory requirement for that.

Now in our country there is some of that. It’s what they call a ranking scale. So if you make X dollars, you pay twenty dollars a visit, if you make twice as much, you pay forty dollars a visit. But the variety in our country is just remarkable. And probably represents the variety of cultures that we have in our own borders.

BAUER: That’s very interesting. Well what about Canada? Everybody’s talking about the Canadians. I used to live in Michigan, and across the border is Windsor, Canada, and everybody went there to shop and now people are going to buy their medicines because that’s cheaper there. But the idea that the Canadians seem to have a system that if you’re in Canada and you get sick, even if you’re visiting, you can get a doctor- what are the trade-offs there?

SARGENT: The Canadians have really done some interesting things. They have a national health insurance. And they pay for care in both public hospitals and private hospitals. But each province, similar to our states, controls the costs. And again, they only cover medically necessary services.

The problem is that, you know as politics goes, they can limit the budgets, and they try to gauge it to what the needs of the population are, but even then hospitals in Alberta, for example, are running 98 percent full. That means in a 100-bed hospital, if you showed up in the emergency and you need a bed, well there are only two left. And so they are running into problems with not enough capacity, not enough beds, not enough doctors. And because they control the costs, and they control the salaries, their doctors, some of them, are coming to the U.S. where they can make twice as much if they’re a skilled physician.

BAUER: OK, so now we’ve got the fact that in China they have shifted to a capitalist system of private enterprise and private businesses and private taxation to pay for a philosophy, which is a communist philosophy that everybody should have equal access. And using the profits of the richer people to help spread it across the country is their big plan. And it’s been in existence now since 1978. But they are saying to people look, we’re all in this pool together. If you’re sick or you have a mental illness, the law says we just as soon that you not have children, because then we’re all going to have to take care of them. And if you’re going to live in the city please don’t have more than one child. If you live in the countryside, that’s different, you can have more. So that they’re making decisions based on this sort of fairness as they see it.

So it seems to me listening to you, Susan, the way in which these systems have developed is that everybody is concerned with what’s fair. And then they vote for a government, or they get a government, as they did in China, that represents the majority opinion about what should be done. And then they craft a system for health based on the idea that everybody would like to be as healthy as they can be for as long as possible, which is where we started this show.

Our system in this country was born in World War II. And I remember my father didn’t have health insurance. They didn’t have that, but they finally got it during World War II, because it was grown in the “good old days” when big businesses and corporate growth and lifetime jobs gave access, and the best medicine with the least waiting time and the most choice, to working people. And almost everybody had a job, and it worked for several, or two or three generations.

And in America, we have a moral philosophy that says that every single American is entitled to the same chance for good health. We all take risks and we don’t know what our genetic patterns are, but that we all should have the same chance for good health.

So the system worked fine. And now look what’s happened. We took our businesses around the globe. Remember the Marshall Plan? And helping both the Japanese and the Germans to get over World War II? And we were doing very well and everybody here had jobs, and at the end of World War II we manufactured and sold to the world.

And then something happened. The other countries where we set up our factories with our money, they recovered from World War II. And they began to sell back to us, and they even began to buy our companies. And their standard of living for most of their people doesn’t measure up to ours. We have the best standard of living in the world, on the whole – even our poor people are better off than a lot of people’s middle class in a lot of other places. But we found out now there are lots of very smart, very hard-working poor people around the globe.

So now these companies that had the kind of health insurance that we’ve had, that you’ve talked about, that has all of these various parts to it seem sort of patched together. How does our idea that jobs come with health care play out in this globalized business world?

And this time we want to listen to and talk with some of the people who are running businesses in the system that we’ve got, where they now have to compete on a global scale.

* * *

ANNOUNCER: So Nancy Bauer spoke with a number of people who have unique expertise and experience in dealing with health care situations. The first interview you’re going to hear is with Linda Gold. She’s the president and CEO of M3I from Silicon Valley in California. She’s also active with the chamber of commerce.

Then Nancy interviews Tonya Jones, president of Mark IV Enterprises in Nashville, Tennessee, and an award winner of the National Federation of Independent Business.

And then Nancy will interview Anna Burger, new chair of a coalition of seven labor unions called Change to Win. She is secretary-treasurer of the Service Employees International Union that led the walk away from the AFL-CIO that is negotiating with the troubled auto industry.

Here’s Nancy and Linda Gold.

Nancy Bauer, CEO and Editor-in-Chief of WomenMatter, interviews Linda Gold, President and CEO of M3I, an entrepreneur who creates new business strategies and then has to find a way to match employee health benefits of her customers in Silicon Valley. She is concerned about unfunded government regulations that are designed to help.

BAUER: Linda Gold, the United States is now in a place where all of our businesses are depending on talent and skills. And your story is one of the great ones about how you built a business based on this, and what happens to it in developing it, and how health care plays into it. So would you tell me first of all, and tell our audience, the women around the country, how you got into this business in the first place? What was your strategy, why did you do it?

LINDA GOLD: OK. I was expecting my first child, and quite frankly could not afford to be a stay-at-home and did not want a day-care baby, so in my infinite wisdom at 27 I decided that I would found a company and work from home, and be able to have the best of both worlds.

BAUER: Aha. And so what was the strategy in founding the company? How come it was not baked goods but it was whatever else you do?

GOLD: I was currently working in high tech and doing documentation and training.

BAUER: I see, so making those manuals that everybody hated.

GOLD: Exactly. So I decided, I actually went to the company, it was in a real downturn, it was in the early eighties, 1981, and went to my employer and said, let’s make a deal. Cover my insurance until the baby is born, and I will work with you on contract and go home and start a business, and that’s exactly what I did. Obviously very early on, health care was a major issue for me.

BAUER: And it is for everyone and particularly I think for women. Why do you think so?

GOLD: Without health care in this country, it’s a very scary place to be. Preventive care is critical, so that you avoid the catastrophic situations of having to go to the emergency room. But without health care benefits, our emergency rooms and clinics are just packed, and the quality and level of care.

BAUER: So that’s a really tough one. So tell me then, you started out your business in the midst of the first downturn that we can remember, that is in ’81.

GOLD: Yes.

BAUER: And you built a business. Did you hire people then?

GOLD: We worked primarily with contractors in the beginning, and again, it was less expensive that way primarily because of health care benefits. As we grew and needed a more stable, solid employee base, we did start bringing on employees.

BAUER: Aha. And so you rode the bubble up, did you? I think that’s a mixed metaphor – can we ride a bubble?

GOLD: [laughter]. We’ve experienced great highs and lows, and it’s been a roller coaster over the past 25 years. But in the most recent downturn, we had some serious decisions to make with respect to employee and expenses, and particularly health care. The HMO that we had been using went out of business. Our health care benefits, because we’re a small company, our choices were limited and the costs were high.

So we decided to go the route of a co-employment situation.

BAUER: What’s that?

GOLD: It’s a PEO, and essentially what happens—

BAUER: What’s PEO mean?

GOLD: A Professional Employer Organization. One of the best known is Administaff. And what that is, is a company that essentially payrolls your employees, provides all the health care benefits, 401K administration, handles employee recruitment, retention in terms of training and professional development. It will manage your personnel files. Essentially it becomes your outsourced HR department.

BAUER: Wow.

GOLD: And what happens in that kind of an arrangement is that you have the buying power of an 80,000-employee company, versus a company of 10 or 20 employees. So I get excellent health care benefits for my employees at a cost that is similar to a large organization, versus the high premiums that a small company would pay.

BAUER: Why is it that a small company has to pay more than a large one?

GOLD: I believe that the cost of the care is spread out over the number of employees. So to take a base cost of whatever it is to cover a person in a year, and naturally, if you spread that out over 10 employees versus 10,000 employees, the cost per head is going to be significantly lower for the larger company.

BAUER: And do you look for people who are going to be healthier? Or do you care whether they’re females or males, or whether they have children or not? I mean does this bother you?

GOLD: Well certainly all of that ties into non-discrimination laws [laughter]—

BAUER: Right.

GOLD: -- so of course I do not discriminate. I can give some statistics in terms of employee demographics. We’re a 100 percent women-owned business, 65 percent of my staff is female, 30 percent of staff is non-white, minority, 80 percent of my senior staff is female. Approximately 70 percent are 40 or younger. About 65 percent of my staff has toddlers or school-aged children.

BAUER: You have absolutely built your company on the demographics of women in this country today, and it’s wonderful to see that you made it possible for people at all ages and stages, and particularly women, to work together in a business that is not a dying business but a growing one.

GOLD: Yes.

BAUER: So when business hits a bad spot – as you say it’s a roller coaster, being in any business there are going to be good years and then something happens – what do you do? You rebuilt your company after the bubble and retargeted what you do? Do you still do manuals?

GOLD: No, no, no. In the mid-nineties, we got involved with the web and started working with Netscape Communications, which was a great launching for us in that field. And by the late-nineties we were focused exclusively on web marketing and website design and development and maintenance. And that is what we do now. We work with companies primarily in Silicon Valley that use the web to drive revenue and increase employee productivity.

BAUER: And so you have to go for employees that have those new talents and who have those skills.

GOLD: We started morphing the organization in the mid-nineties and were doing both technical writing and web design and development during that time period. And then as we moved forward into the nineties, I had to make a decision about who we were – were we a decorating company or a web company? And realized that the passion for me was on the web side of things, and I felt that was the direction that the industry was heading in.

So we cross-trained the writing team, or if they chose to stay in documentation they were able to leave with my blessing. And then we just continued to add to the web staff that we had already.

BAUER: Well this is really wonderful – a story of how business can stay alive, and the way in which you match your strategy to your employee base. So does offering health care help you get the people you want, and if so, is there a way that you can help them, or they help themselves stay healthy?

GOLD: Well quite frankly, my customer base is primarily large, high-tech organizations that have fabulous benefits. So for me to be competitive and for me to be an attractive employer, I need to offer those same types of benefits. So my employees have health, dental, vision, disability, life – pretty much all the benefits that a major corporation will offer. If I did not do that, I would not be able to attract and retain the high-quality, educated workforce that I have.

BAUER: That’s fascinating. So that productivity and health care are part of the competitive place that you live in, in Silicon Valley. You’re selling to people your services, and you’re competing with them for talent.

GOLD: Absolutely.

BAUER: What an interesting thought. So this is a company that’s doing work, that’s not going overseas. And so does what government does make it make it easier or harder for your responsibilities? That is, what we’re trying to do in this country philosophically what you’re doing, can we turn that into policy?

GOLD: I personally am opposed to the government mandating that businesses provide health care coverage at the employer’s expense, for small business. I do it because I believe it’s the right thing to do, and it’s part of my business strategy and I make sure that we provide those benefits if we can pay for them. But I will tell you that there are countless organizations and sectors in the small business arena – restaurants, nonprofits – that if mandated to provide health care for their employees would go out of business. It would cost jobs. No questions asked.

BAUER: You’ve made both a philosophical commitment, a moral commitment as you describe it, and a business decision. And they’ve worked together. What do we do as a nation? This is a country that people who don’t work for smart employers like you, who had a new business strategy, they get stuck. So if we could have shared risk, such as what about a different kind of insurance, job insurance – if I work for an employer who’s not as smart as you, and I do my very best but that business goes out of business and then I lose my health care.

GOLD: Right.

BAUER: So that should we as a nation- you talked about outsourcing to this organization which could put you in a much bigger pool, think about a national pool, or a regional pool? So therefore if you’re younger or older, sicker or weller, lucky or unlucky, the shared risk is spread over a much bigger area? Is there any way that you see where we can have that kind of a national philosophy and still give individual employers the kind of flexibility that you knew how to use?

GOLD: I think it’s absolutely possible. It won’t happen quickly. The health care system is so broken at this point in time, and we’re looking at so many silos – the insurance companies, the service providers, the doctors, the surgery centers, the hospitals. All of them maintain different databases; all of them have their own records. All of those processes are so labor intensive, and therefore wrought with potential for human error.

I heard a health care expert speak the other day at a conference who said you have a better chance of your luggage arriving on time at your destination than you do to get the prescribed, or the precise treatment for your prescribed prognosis.

BAUER: Woops. Now there’s a metaphor that speaks to me, as I’ve been waiting for mine for four days. [laughter]

GOLD: Yes. [laughter]. I think there are definitely solutions. I think technology plays into this dramatically. Health care is one of the last industries to adopt technology.

BAUER: And so it’s not one industry, as you describe it. You talk about silos and I can just see them on the farm, on farms and on the horizon – one stove pipe after another as opposed to one system.

So what can women do to help get the country to pay attention to the kinds of things that make it possible to have the work-life you’ve given women at different stages of their lives, with or without children, over good days and bad? You’ve made it possible for women to have a career. And to have a business that is flexible and lively. What do you think women can do, or should do, to help this nation develop a national policy that would suit your needs, and at the same time not require a small business that’s just getting started to go bankrupt over health care?

GOLD: Well I’m a big believer in getting involved in public policy. I think we need to seek to make our voices heard about the importance of health care, and of good solid coverage for our nation’s employees. Whether you do that through membership in your local chamber of commerce, or the state chamber of commerce advocating on behalf of business, whether it’s through NAWBO, the National Association of Women Business Owners, who advocate in Washington and at the state level, or whether it is a local public policy group, calling your congress person, calling your state senator, calling your local city council person – we need to speak out. We need to get the message out.

* * *

Nancy Bauer, CEO and Editor-in-Chief of WomenMatter, interviews Tonya Jones, President of Mark IV Enterprises, a prizewinning entrepreneur in the construction business who battles insurance companies that don't want older employees

BAUER: We’re talking to Tonya Jones, who is as she says, chief cook and bottle washer, and president of Mark IV, a major general contractor in Nashville, Tennessee. Good morning and tell me about how this business started, and how you make it go.

TONYA JONES: Well I guess I wish that I could give you a parameter of just how it started – it evolved. I had gone through a divorce, I had been working for a general contractor, I was passionate about the whole construction industry. And in Nashville, Tennessee in 1985 women really didn’t participate in construction; it was just a real no-no. So I knew, or I really didn’t believe I could get a job doing what I wanted to do, which was project management. So I decided that the best thing for me to do was start a construction company, because then at least they wouldn’t laugh me out of there.

BAUER: Aha, and that put you in control.

JONES: [laughter]. It kept me from not getting hired. I didn’t think my fragile ego at that point could stand the rejection, so I just kind of copped a plea, if you will. And I had a couple of people that I had worked with in the past, and they helped me with a couple of projects. And then next thing you know I had another one, and then another one, and then here I am 20 years later.

BAUER: What makes one passionate about construction? I mean people are passionate about chocolate chip cookies, but this is—

JONES: [laughter]. Well all my experience prior to that had been in training realtors and setting up offices and helping with guidelines for real estate offices. And I don’t know, it’s so frustrating to teach people to do things, because you don’t have any real control and it’s very difficult to measure training people. You know, this is production oriented, it’s about relating to other people in sales. So it’s real touchy-feely, it really wasn’t anything I could get my hands around.

And when I got the opportunity to run a job, while I was setting up a real estate office, by the way, I just fell in love. You could see the results, you could plan, you could map, you could bring a whole lot of things together, create something that you could visualize and see that was permanent. And it was such a turn on. It’s still a turn on. [laughter].

BAUER: That’s wonderful, the idea that construction is a touchy-feely business is really wonderful. Because this idea of quality control is a very serious one.

JONES: It really is. But you know you can monitor that, and you have to stay educated and you have to be aware of what’s going on. You have to have process, and we’re known for that, and I guess I figured it out.

BAUER: So how many employees do you actually have in this business? And how do you get the job done with whatever number of employees you’ve got?

JONES: I have nine direct employees. Including myself there are four in the office and five in the field.

BAUER: And you can manage large enterprises? I understand you’ve got a piece of the new symphony center.

JONES: We do. And we have a piece of the MTA transfer center. So we can manage it without. We subcontract a great deal of our work, we self perform certain different categories. But my guys in the field are all very talented carpenters; they’re all super in terms of quality people. They understand their paperwork and they can flip in and out. So if we’re slow they can all work together, and if they’re not I can spread them out over as many jobs as I need.

BAUER: I see, so these are all independent businesses? The carpenters? the electricians?

JONES: Oh no, no, no, no, they’re direct employees.

BAUER: I see. And so, do you have health care for them?

JONES: We have modified health care for them. We have really not a good story with that. Some of my employees have spouses who are covered by insurance. And so that leaves four of us who are uninsured currently.

We have a, I call it a Band-Aid kind of policy or policies, that are basically about reimbursement kinds of things that come with a discount, a prescription card. And so this isn’t what we call health insurance, but it is better than nothing. And I outsource my payroll through a staffing company, and they offer a selective offering of different Afflack products. And so several of our people have several of those. But it is not health care as you and I would know it.

BAUER: Would you like to see health care offered to everybody so that it would get off your back? Or do you think that this really is part of the responsibility? How much individual responsibility should there be in the best of possible worlds? What do you want?

JONES: Well, what I’d like is to be able to compete with other people in my industry for hiring. That’s a big deal, and health insurance is a very huge subject and issue in hiring. And I think it gives me a real disadvantage that I can’t get a true health care program.

Let me back up. The reason I can’t, there’s a couple of reasons. And it has to do with the structure of health care, at least in Tennessee. And that is, if you’re going to have a group, your group has to be 50 percent of your employees. Well, 50 percent of my employees are insured through their spouses. So I’m one short to start with, and I’ve tried to play the game of hiring somebody to get this done.

The bigger issue, I have two issues, one is the average age of my employees is about 54. And that includes me, which I’m over that, so I kind of tilt it as well. But practically, that’s not who they want to underwrite.

BAUER: So they’re in a sense, they’re looking at your employees and saying, if you’re older you’re going to get sicker, because that’s what everybody does.

JONES: I think that statistically their actuaries say, these are your break points. And obviously, we’ve been together a long time and we are aging. We had health care for 18 years through our staffing service, and we got dropped as a company because of worker’s comp fears as a general contractor. So we lost our insurance a year and a half ago. And I have literally tried every avenue I can do to get my five or four and a half employees under a group.

BAUER: And that’s really hard, one because of their age. And the other thing is, you’re really shopping for some insurance company that will realize that you know how to run a business and you wouldn’t have people there that are going to fall off the top of a building and get hurt.

JONES: Absolutely not, and I’m pretty sophisticated when it comes to those workers comp issues, because we started a trust here in Tennessee to manage those costs. But the health care we can’t get our hands on. There are a lot of issues. Tennessee has a number of mandates that every insurance company has to cover before they can even rate in insurance in Tennessee, which makes us kind of a higher rate than anywhere else.

BAUER: Is this the state that doesn’t have income tax?

JONES: It is a state that does not have income tax.

BAUER: So the state doesn’t feel that it has the money to support this at a state level.

JONES: That’s not the issue. The issue is a political game. They have put mandates such as apparently some constituents had a baby and the baby was allergic to breast milk, and so there was some reaction. So the state put a mandate on all writers of insurance in the state of Tennessee that they had to cover all women for this event.

BAUER: How many of your employees, there are nine employees, are female besides you?

JONES: There’s three of us that are female. Two of them are breast cancer survivors.

BAUER: So then once again, it’s one’s own personal health history putting the tables –

JONES: [laughter].

BAUER: We’re in a gambling game. I mean it’s a lottery that we all buy insurance because we’re betting we’re going to get sick, and they give us insurance because we’re betting that we can stay well. What do you do about- do you have any fat smokers in your group?

JONES: No, we do not. But you know, there’s a tragedy that’s going on here that I think takes over broadly the whole insurance crisis if you will. We have several things going on. The medical profession continues to lower the thresholds for major diseases, such as diabetes and high blood pressure and cholesterol.

BAUER: What do you mean by lowering the threshold?

JONES: Well you know it used to be anything over 140 milligrams was your high risk for diabetes, or having diabetes. Well last year they dropped that to 130. Well they snagged how many more people?

BAUER: I bet people when they get the numbers from the doctor have a hard enough time trying to understand what they mean, but the fact that that’s going to make a difference to the company that hires them, and to the insurance company that’s going to make a deal with the employer. . .

JONES: Well first of all they just caught a huge group of new people that may have been 130, 135. By lowering the threshold it’s that many more people that they don’t have to underwrite. That’s number one, I think. And number two is that there are federal laws that as an employer or somebody that’s just interviewing someone, I can’t ask about their health insurance.

BAUER: Aha.

JONES: So, that’s federal law. So I may hire somebody that absolutely tanks the ability of the rest of my group to ever, ever get insurance.

BAUER: So the law says you can’t ask them and the insurance companies say that they gotta know.

JONES: There you go.

BAUER: Oh, another Catch-22.

JONES: Well they’ve hugely got us bound. And the truth is that in Congress, they have had legislation for several years for AHP, which is Associated Health Care Plans. They got through the House almost every year. They have never gotten out of the Senate. And they haven’t gotten out of the Senate because your major corporations don’t want small business competing for employees and the major corporations are exempt from these laws on health care.

Second is, your labor unions coerce the same issue. And third, your big insurance companies. They don’t want to have to insure people that have any risk at all. They make money if nobody gets sick.

BAUER: OK, so WomenMatter is trying to bring together women from across the country at all ages and stages. We’re the ones who manage health care at the point of service. We’re the ones who take the mother-in-law to the doctor.

JONES: Absolutely.

BAUER: And so that what can we do, and what would you suggest to women who are our audience and are part of our community, whose responsibility is health? And how are we going to get together? What would you like to see as both policy and practice in this country?

JONES: Well there are a couple of issues. We’ve gotten way out of balance on health care. People think this 10, 20 dollar co-pay is cheap. We run to the emergency room, we don’t manage to take responsibility for our own health. And we have flooded the system with a lot of minor claims, but it costs the insurance companies and so it’s a huge battle that way.

If we take some responsibility for our health and we have some catastrophic insurance, which is what I think insurance should be about, you know we’ve really changed our mentality about insurance, but if it’s for catastrophic events – a hear attack, a major surgery, those kinds of things – to be sure that our family is not tanked financially if some of these events occur. And get out of this mode of running to the doctor all the time.

BAUER: I see, until on the other hand we need to know a whole lot more about health so that we can understand what to do to prevent getting in trouble.

JONES: And I think that’s available now, and we do need to take more responsibility in the way that we eat. When we’ve got a nation where obesity is off the charts like it is, then we’re not taking responsibility for our health. And as a woman especially, with the complicated issues we have, we do need to be responsible for our families, and even our employees in trying to manage health.

OK, I think that every employer, honestly, would like to offer health insurance. It’s a very competitive job market. It is a benefit, it is an expense to the company and it’s something that we can offer to an employee. But with the rules in place, and the lobbies in place, and all the other events that are going on, it becomes impossible, and then we have this huge group of people in the small businesses that are uninsured.

What I was going to tie this to is that 20 years ago our country was dominated by big business. And everybody, a lot of people – most people – were insured by government or big business. Today the culture is very different. There are so many small businesses, so much more. We drive the economy, but the laws haven’t changed. The rules haven’t changed. And so we’re in a Catch-22.

BAUER: Well women across the board working for all these various lobbies that you talked about are the ones who all have a lot in common. So together we could possibly make a difference in what the policies ought to be.

JONES: We should be. Women are the fastest growing part of the economy, women businesses. And the truth is, is that if we stomp our feet and we call our senators and we find out about how these laws can help us and we band together, I think we can make a huge difference.

BAUER: That’s what Facts and Trade-offs is all about and you’ve been an help enormous this morning. Thanks so much Tonya Jones from Nashville, Tennessee.

JONES: Thank you.

* * *

Nancy Bauer, CEO and Editor-in-Chief of WomenMatter, interviews Anna Burger, Chair of the coalition of seven labor unions called, Change to Win and Secretary/Treasurer of the Service Employee's International Union

BAUER: And so can you tell us first of all about your new collection of unions and how they fit together?

ANNA BURGER: Well Change to Win is a federation of seven international unions representing close to 6 million members who believe that it’s important for working people to have a louder voice in our society so we can change our lives. And we believe that the way to do that is to organize workers so they can have a greater say, and we can actually make sure that working families are treated fairly, that their work is valued, and that they have a fair chance in our society.

BAUER: Well then how does that fair chance work with health, health care and jobs?

BURGER: Well we believe that Americans should be able to support a family on their job, that they should have a sustainable wage. We think that every single man, woman and child in America should have access to health care. It should be a right, not a privilege.

BAUER: OK, so it comes with the citizenship, or it comes with the job?

BURGER: We think that right now we have a health system that’s based on employers providing. And we think that we need to look at the whole system and change it. Right now we need to defend the employer-based health care system. We should expand it where we can. But we really need to look at ways of changing that, because in some instances it makes our employers not competitive.

BAUER: Uh-huh, so that you have compassion for employers do you, is that a new one for the union?

BURGER: I think that we need to have employers be productive. We just think that they need to share their prosperity with their workers, and they need to treat them fairly. We do believe that it’s important for our corporations to be able to be competitive with other parts of the world so that we can actually raise standards and hold our standards. And so we do think that it would be worthwhile to be able to sit down and partner where we can with employers, but where we can’t partner with them then we will take them on.

BAUER: Aha. And so with this partnership, what happens with your members specifically? For instance, do your members get to choose a health plan?

BURGER: It depends on what we bargain with our employers. Quite a majority of our workers, when we first organize them, don’t have health coverage, and we bargain to get them health coverage. And so sometimes it’s through a health and welfare fund, sometimes they have options; sometimes it’s by the employer providing it directly.

BAUER: I see. What’s a health and welfare fund?

BURGER: It’s a way of pooling money of multiple employers to be able to fund and purchase benefits in a cheaper way.

BAUER: I see, so this is like all the little companies in the chamber of commerce that get insurance for their guys, you’re doing the same thing for the workers?

BURGER: Yeah, we do it in partnership with the workers and the employers.

BAUER: A lot of your members, I guess, are women, right?

BURGER: Yes, more than 50 percent of our members are women. It’s about 58 percent.

BAUER: Wow. And we’re 52 percent of the population, so 58--

BURGER: And we do a lot of, my particular union, SEIU, our union organizes a lot of low-wage workers – home care workers, child care providers, who are majority women. And all of our unions, in Change to Win, we’re oftentimes organizing the service sector, and they’re oftentimes women workers.

BAUER: So that’s what the “S” in SEIU is for?

BURGER: SEIU is Service Employees International Union, and CTW, which is a federation, is Change to Win.

BAUER: Your female members, which are more than 50 percent of your total membership, of your millions of members, what do they seem to want when it comes to health care? What do they tell you?

BURGER: They tell us that they want to make sure that they can take care of their kids. And oftentimes, one of their number one priorities is making sure that they have adequate health care for their kids and for themselves.

BAUER: What about single women? I mean there are an awful lot of women--

BURGER: No, I mean that they also want it for themselves. Right now, they worry about having access to quality, affordable health care. And so all of the issues go together: to make sure that they have access, that their doctors around them will provide them coverage, that it’s good quality, and that it’s affordable. And so depending on the woman and the occupation, affordability is a big issue.

BAUER: So affordability. The less money you have the more affordability is more important than quality?

BURGER: Well I think that affordability is always an issue, but it becomes a greater impact if you can’t afford a doctor’s visit because you’re making minimum wage and you’re already working two part time jobs.

BAUER: How do they know about quality? What do you tell them or what do you have to do to help them understand what quality is?

BURGER: Well I think workers and women know quality when they see it. If they are always kind of scrambling to try to find a doctor who will provide care to their kids, if they’re depending on emergency rooms because they can’t afford a doctor’s visit, then they know that they’re not getting the kind of care that they really want for their families.

BAUER: But the ER doctor may be a better doctor than the local one around the corner in the neighborhood.

BURGER: But they might not know them, their medical history and what’s really going on with their family.

BAUER: Aha, so there’s a trade-off.

BURGER: Yes, and I think that right now people are trading lots of things off in trying to survive. Because if you think about what’s going on with working families right now in our country, there are a lot of people, especially women, who are working multiple jobs to try to make ends meet, that they don’t have health care coverage from their employer. They are trying to piece it together any way they can, they worry that if someone in their family gets sick that they’re not going to be able to pay their rent or the doctor’s bill. And God forbid that there’s a serious illness, that they’re afraid they’re going to go bankrupt.

BAUER: So can you explain, when you work with them, can you explain a trade-off, a cost to them? You have to negotiate with their current employers.

BURGER: We negotiate.

BAUER: Can you explain to them what you had to trade off to get the deal you got them?

BURGER: Well no, I think that what we do is our members bargain with us.

BAUER: Ah, how does that work?

BURGER: I mean we organize workers, and we organize the majority of workers, we then talk to the workers about what their core issues are and their critical issues are, and we form a bargaining committee so that they are actually part of the bargaining process with our employers. We then try to work through what the different issues are so people are clear about what their priorities are and what will it cost, and what we need to do about it.

BAUER: To what extent do people on those committees recognize that they’re in the pool with each other? That when we get a health plan that, for instance, it costs me more if I’m in a pool with fat smokers? How do they feel about each other in this? I want health care for me and my husband, but we don’t have kids and now we’ve got to be in a plan with kids, and people with kids are going to send my co-pay up?

BURGER: I think that we all are in our communities. While we’re all individual people with our own individual circumstances, our circumstances can change overnight. You know, we might be a single woman today without many health care costs, and tomorrow we might be diagnosed with breast cancer or something else. We might be in a family where everybody’s been healthy for a long time, and all of a sudden they’re not. So I think that the idea of trying to figure out how we provide health coverage for every single man, woman and child in America so we’re not trying to pit people against each other is a really important thing.

In the union movement, what we try to do is pool workers together so we can have a common approach and a common answer to our collective issues, and to do it in a way that is responsible to each other, and also responsible for their employers.

BAUER: So this idea of responsibility to each other and to the employer, what happens then, for somebody who’s a fat smoker, who doesn’t want to exercise? Does that get to be part of what you negotiate for? Do the employers make it possible, or do your union members have to sign up and promise to go to the gym?

BURGER: I think that’s a whole issue. I mean you might even want to do a whole show sometimes on wellness programs. Now in a lot of health programs there are wellness programs to help people stop smoking, to help people deal with weight issues, help people deal with regular medical problems, how to treat diabetes and diabetics in a way that is more productive on the short term. So there are lots of wellness programs that are being created and are becoming part of insurance plans, so that we can actually help people move into a healthier lifestyle. But part of it is making it available to people.

BAUER: Oh that’s great, and we certainly can do a future show on wellness programs, and alternative programs as well. And by the way we appreciate what the unions have done with making sure that not only is Viagra covered but also health care for women.

BURGER: It is a critical issue, and the reality is when the labor movement was strong, in the 1950s, when one out of every three workers in the private sector was in a union, workers had a decent job. They actually had health care for themselves and for their families. There were more people covered through the employers back then than there are now. We think that if we could actually organize more workers we could have a collective response to the issues of our day. And health care is, I think, the number one issue facing working families, and women in particular.

BAUER: And if 58 percent of workers are women, how many of those women are on the committees?

BURGER: In our union women are incredibly active. We have women active at all levels of our union. We have them active in the workplaces, we have them active in the leadership of their locals, we have them active in the bargaining committees. We believe that we want to be as reflective of our membership at all levels of our union.

BAUER: So that you’re not just targeting the healthier people or the sick, that you’re trying to get them all into one --

BURGER: No we’re trying to organize all workers in our industries.

BAUER: And to understand each other, hmm.

BURGER: Yes.

BAUER: Is that hard to teach?

BURGER: No, I think that working people understand that they’re facing a tough life right now, they want to raise their standards and they want to raise their neighbors’ too.

BAUER: I see, so that’s an economic thing. The big one is quality of life then?

BURGER: Yes.

BAUER: So let me ask you this then, if you had a private moment with the most powerful individual at the largest employer and could say, look, we all know that a healthy workforce is a productive workforce, let’s do this. What would “this” be? What would you ask for?

BURGER: I would ask them to partner with us, partner with the workers and the labor movement, to struggle through the real solutions to health care in our country.

BAUER: And three years from now, when you look back on this new job and what you’re doing, what’s going to make you most proud?

BURGER: I’m going to be most proud when we have united workers, they have a louder voice, and we’ve actually won health care.

BAUER: That’s great. We’ll be back to talk to you again, and many, many thanks for this. We’ll be watching for you and we will be posting what’s going on, we post three times a week on www.WomenMatter.com, dot-net, and dot-org. (add link)

BURGER: Thank you very much.

* * *

ANNOUNCER: So Nancy and Susan, listening to those three interviews, we have three clearly brilliant women dealing with the health care issue in three different, unique ways. What did it say to you about where we’re going if there are so many different ways of dealing with the situation?

SARGENT: I think it’s really interesting, because as someone who probably could be accused of being a control freak, what I heard going across the board was women really have to take control – as if that’s something we needed to be told.

But in terms of Tonya’s comments about doing, versus teaching or following, you know, she needed to get results, she needed to have a plan. She needed to have standards going forward for her employees, for herself, for what she did for a living. This was ultimately the key point. And to do that she needed to know the facts and the trade-offs of what she was doing, and it really plays directly into what we’re trying to talk about today. And that is to have the health care. Obviously if you’re healthy you don’t need health care. But at some point you will.

ANNOUNCER: Nancy, how have your perceptions changed since you’ve interviewed these three women?

BAUER: I have a very different view than I’ve ever had before, because I’m one of those, I’m married to somebody who had a great health care plan, with big business. And therefore supposedly they’re supposed to pay for me, although he’s been retired for years and if I live to be 102, that company is supposed to pay for me. It’s looking today as if this may not happen, but it is very interesting to hear these women because they are the women who are dealing with the current economy. It’s not just health care. Those two entrepreneurs, they’re the ones that are creating the new jobs in this country. The big businesses are outsourcing and cutting back and putting in technology. But there are some kinds of jobs that have to be here.

And so Linda Gold is in web design. It could have been done some place else, but she’s had to invent a business strategy so that she could employ herself and other people, both men and women. And in order to get the best talent so that she can be in business, she has to continually change her business strategy and make it more technologically up to date, more high tech – the latest thing – she can’t stay with old stuff.

So she’s reinvented her business strategy three times in the 20 years that she talked to us about. And each time, at one point business was so awful she had to let people go and she hired people on the outside who had to buy their own health care. Then she invented her new business strategy, and she needed more people, who knew more, and so she would retrain them, but if they didn’t want to be retrained they had to leave. But for the ones she’s kept, she has to have health care because she’s competing, as is Tonya Jones.

And I really wouldn’t have thought of it until – one in construction and one in high-tech web design – and both of them are selling their services to companies who have the same kind of workers they do, and therefore they have to have the best workers, or they can’t compete. And those big companies they sell their services to, those companies all have health care.

So Tonya Jones talks about the fact that when she hires men who have been with her for so long they’ve gotten older, and a 57-year-old man gets dumped out of the health care system, what she has, she doesn’t fire him. She hopes that he’s married to a woman who maybe works for a hospital, or for a school district. There are lots of men who make more money than their wives, but whose wives have the health care because they’re with some agency which may have a union, which got them a health care plan.

And then comes Anna Burger, who’s talking about the thing that Susan was talking about earlier. What do we do in this country about all the people who have less education – some of them immigrants, some of them people here in this country that just have not really participated in the educational system and the job development system which worked for so long in this country. And what happens to them? She is bringing them together to get them into the health care plans that we’ve got now. And Susan, how does that work?

SARGENT: The SEIU [Service Employee’s International Union] and other unions like that are fighting tooth and nail because of the outsourcing that you discussed before. Because when a company goes and outsources their telephone support systems to India- or take one of the countries we’ve reviewed, let’s say if they outsourced them to China, and that care is already paid for under a government sponsored system, they are much more competitive. Therefore it makes more sense to be employing people in China than within the unions here. And then the unions are at a disadvantage for negotiating coverage. It’s very, very challenging.

But I think, number one, the women that we’ve interviewed all have taken control. And I think it was Tonya who said the growth in women businesses is driving the economy right now. And so the need for knowing the facts and trade-offs in health care, from an employer’s standpoint, from a union negotiator’s standpoint, and from a union member’s standpoint, have never been more critical.

ANNOUNCER: So let’s move forward and learn a little bit more about some of the facts and trade-offs with Nancy’s next two interviews. Nancy Bauer interviewed Daniel Soderberg, assistant vice president of product development at Penn Mutual Life Insurance Company. She then interviewed Congresswomen Allyson Schwartz from Pennsylvania’s 13th district, who had also served for many years in the Pennsylvania State Senate.

* * *

Nancy Bauer, CEO and Editor-in-Chief of WomenMatter, interviews Daniel Soderberg, Assistant Vice President, Product Development at Penn Mutual Life Insurance Company. He describes the burden carried by large corporations who have generations of retirees - all of them and their families owed health care under union contracts. Now these once great success stories face competition from Asia and Mexico and their low cost skilled workers.

BAUER: We have on Facts and Trade-offs Daniel Soderberg, assistant vice president for product development of Penn Mutual Life Insurance Company. Dan and I met when he got his master’s degree with me at the University of Pennsylvania in organizational dynamics, and 13 years ago he wrote a master’s thesis which said that the day that General Motors decides that it cannot afford the retirees health benefits, this country was going to have to change its entire health care system.

When I showed the paper to my colleagues at the university, they said, he doesn’t deserve a degree, this is ridiculous. Well, this is the week in our history when it has happened, and Dan is the oracle who saw it coming 13 years ago.

So Dan, very interesting, WomenMatter, Facts and Trade-offs has been unable to get any of the major corporations who are in this same spot as General Motor, the major legacy corporations, to come on the show. So I’ve asked you to come and talk about the situation they are in. And your own company is not involved like this. But tell me about these other organizations. What’s the spot they’re in? Why are they doing what they’re doing?

DANIEL SODERBERG: The spot they’re in is one that actually goes back to, for many of these companies, the second World War and their interest in bypassing some of the price controls and wage controls that were in place.

And what they figured out at that point was that if they gave employees health care it was a way to essentially attract and retain employees that otherwise they wouldn’t be able to have. And essentially momentum started out of there, and they decided that this was a good deal and ultimately tax laws were changed after the second World War that gave advantages to larger employers in terms of the deductibility of health insurance.

BAUER: Aha, you mean that if they give health insurance to their employees, they don’t have to pay taxes on that?

SODERBERG: No, basically it comes right off as any other ordinary business expense, so that, and essentially from a tax point of view, they don’t pay FICA tax on it.

BAUER: What’s FICA tax?

SODERBERG: Social Security tax, or Medicare tax. But what they do is they pay the health insurance premium, and they get a business deduction from that no different than for the electricity that they use to light their plants. So it’s a very effective way of transferring money to an employee very tax efficiently, and because of the way the tax law are constructed the larger employers are put at a tremendous advantage. And basically have reaped the benefits of it- in that over these last 40, 50, 60 years, larger employers provide these benefits, a nice benefit package.

You know originally they started out with defined benefit pension plans and decided that wasn’t so good.

BAUER: A defined benefit, what’s a defined benefit? Who gets to define it?

SODERBERG: Well the retirement plan itself defines it, and it’s in many ways akin to the Social Security discussion that we’re having today, where under Social Security, when I get to be I think it’s 66 years old, I get a monthly pension for the rest of my life. And if I die sooner my spouse would end up getting a benefit for the rest of her life.

A lot of major employers, part of their economic transition over these last 20, 30 years has been to look at that kind of long-term commitment and say, I’m not willing to do that, that is essentially absorb the investment risk. Because in a defined benefit plan if I promise you a dollar a month, I’ve got to earn whatever I can earn. The more I earn in terms of investments that I may set aside to cover benefits, the less I’ve got to make in terms of contributions. But on the converse, if I don’t earn good rates of return, then I’ve got to pay more.

So when you saw the advent of things like 401K plans, what employers were saying was, you save the money. Yes, I’ll put matches in there, I’ll put money in there, but essentially your account’s going to earn whatever it’s going to earn and you get to retire at whatever it might be.

BAUER: So the company doesn’t want to be responsible for good luck or bad luck.

SODERBERG: Correct.

BAUER: They need to spread out those ups and downs --

SODERBERG: Yep.

BAUER: --over a period of time, and they want to share that with the employee. Or if they can, I guess these days some of them would like to give it entirely to the employee.

SODERBERG: Correct. And again, for the larger employers, they’ve used all of these types of things historically. Many of us have heard of people, in party situations, just in normal conversation, you know, “I’ve got to get a job with benefits.” And what they are saying there is that they want a job with health insurance benefits. And it’s a recognition of the fact that to get those benefits on my own is very expensive, in many cases I can’t get it, or if I’m working for a small employer, that small employer may not be able to afford it. So again, as you can see it’s created historically a very definite advantage for large employers.

BAUER: And it worked, of course, in the years when the employers were getting bigger and bigger and taking their businesses overseas, and we called it international business and global economies. Now of course they’re out there in the global economy, and the competition is much rougher because the world is full of a lot of very smart poor people who can do the job someplace else.

SODERBERG: And you know part of it is some of these other economies that you’re talking about, for example India or some of the Scandinavian countries, have been able to compete on a global basis and have a lot of what people refer to as socialized medicine, and it seems to work for them. But I had an experience a week or two ago calling for my car insurance, and ended up talking to someone who I’m sure was sitting in India somewhere, for Allstate. And it really surprised me. And when I asked enough questions I ended up getting shipped to an agent who was in the U.S. I’m sure somewhere.

But with technology today, a lot of jobs can be moved around. And if you don’t have a business that’s got a good profit margin and a good long-term perspective, the cost of health care, the cost of defined benefit pension plans are things that generally employers are starting to shy away from.

BAUER: And of course that era is over, and if you’ve been in business a long time, you’re at a disadvantage for the newcomers, because newcomers don’t have as many employees and they don’t have the history of all those retirees. But some of these companies have been in business for what – my father’s generation, my grandfather’s generation.

SODERBERG: Yep.

BAUER: It’s about, I guess my granddaughter, five generations of employees in a place like General Motors or Lockheed, or any of these other companies that have been famous for American prosperity. And they’re stuck then.

SODERBERG: And think about it this way too. What those employees were essentially bargaining for was a commitment that I’ll take less in wages now, cash wages, in the prospect that I will get retiree health insurance, for example. Or other types of benefits that go beyond when I stop working. That’s some of the contracts that are in jeopardy today, those commitments.

BAUER: I see. And so what are the ways out for them? The large companies can bargain with their union.

SODERBERG: Right.

BAUER: And of course the unions, we’ve just seen a breakaway in the union movement. The unions that are able to do their work with people who are not insured at all, have pulled out of the UAW-CIO, and formed a new group because these are people that they can go get basic insurance for and bargain for, leaving the UAW-CIO and some of these other large groups bargaining for an agreement which is historically almost impossible for both sides, for the workers and the employees. And for the retirees, I guess in the small print it says the retirees can have this policy changed any time and they haven’t any recourse. A retiree can’t strike.

SODERBERG: No, and you know they may have some recourse in the courts but the reality is in some of these cases, you can’t get something from nothing.

BAUER: Aha, if the money isn’t there, you can’t get it.

SODERBERG: And the fact that in some of these industries that have existed for, some of them, 100 years, the economics of their business isn’t what it once was. Now Nancy, you and I have talked before about companies like Starbucks that basically recruits based on offering health insurance and other types of basic benefits to attract a workforce. The business model of something like Starbucks, obviously paying two dollars for a cup of coffee, has margins in there that enable them to be able to do that, and if you notice the type of people that are attracted to work in those types of places, they’re very polite and they, are probably paid very well. And I don’t know the details of the benefits or the employment relationship.

BAUER: And they wouldn’t be interviewed for this program, we tried.

SODERBERG: Mmm-hmm. But again, there is an example of a company today that says, for me to compete in the marketplace to get the kind of worker that I need, who, quote, wants benefits, I need to do this. And my profit model, my business model says that I can do this if I do this, this and this, and I don’t know how many corners you run by today where you don’t see one of their stores.

BAUER: That’s really interesting, because then when I buy my latte for two dollars or three dollars or whatever it is, I actually should get a tax deduction for my contribution to the health care system?

SODERBERG: Oh I don’t know about that.

BAUER: [laughter].

SODERBERG: But you’re certainly making a contribution to the efforts of Starbucks and to their employees.

BAUER: Right, and the other way out, there’s a third way out, is bankruptcy. And we now have a new bankruptcy law passed recently in this country, and with that, and the deadline for declaring bankruptcy is the middle of October 2005.

SODERBERG: Right.

BAUER: And Delphi, one of General Motors, the largest provider of parts for them, has declared bankruptcy, which means that they, then, don’t have to pay retirees. And if they come out of bankruptcy and stay in business they can have a whole new deal and don’t have to even have a union necessarily. However, that would go to the courts, probably, to decide what kind of a deal was made and does that hold up. So we’re really at a critical point at America’s history, and you Dan Soderberg spotted it 13 years ago, and I trust that the University of Pennsylvania now knows how right you were.

SODERBERG: Well and some of it is based on the economics of the way our current health care system works or doesn’t work. I’m a consumer of health care working with a provider of health care, and I’ve got an employer paying the bill. So I have no incentive to be cautious or wise with my consumption of health care, the doctor-medical-hospital establishment certainly has no reason, and that’s part of why you saw managed care and HMOs and some of that stuff start to show up in the ‘70s and ‘80s. And that the employer’s constantly sitting there with the bag saying, OK, how much money is this going to cost me?

And then the other aspect of this thing is to be able to predict cost from one year to the next, and then to be able to deal with the cost increases is very disruptive to many businesses.

BAUER: And that’s really a tough one, and we have to look at what will happen if they go to handing the employee, the day he or she retires, she gets a lump sum of money and is told, go buy yourself your health care.

SODERBERG: Right. And many employers at this point are putting future retirees in the position of not offering health care. Their issue right now is those that have retired, where they’ve made commitments. But many employers at this point have already started to cut off – most, I would think – offering retiree health care.

BAUER: Thank you very much. We want women across the country to understand how this impacts all of our lives, since they manage the health care for the families and their parents and their kids, and themselves. And how they work with their employers and what we’re going to do in the future so that women together can make this, get these messages out. But thanks Dan.

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Nancy Bauer, CEO and Editor-in-Chief of WomenMatter, interviews Congresswoman Allyson Schwartz from Pennsylvania's 13th District who describes what government does now and what it could do to make health care possible, including setting standards for large regional pools of Americans while maintaining private competitive insurance companies

BAUER: Talking to Congresswoman Allyson Schwartz, first term congresswoman from he 13th district of Pennsylvania, who has had a major career in health care, in public service, and in both state and federal government. So Congresswoman Schwartz, how did it happen in your life that you got into public service? Where did it come from? Was it a woman’s thing to do this, this way?

ALLYSON SCHWARTZ: Well first of all Nancy, it’s really exciting to be on your first show. And the work that you’ve been doing in reaching out to women has really just been so important, because as you know, I believe quite strongly that what we do in politics matters in our lives, certainly as women but as all Americans. So I’m really pleased to be on with you today.

So as to how I made a decision to be in public service really from sort of the get-go, I suppose, is something that comes from my own family history as it often does. My father was a refugee to this country, so I’m a first generation American. And my mother’s life as a Holocaust survivor in coming to this country certainly taught me that she loved this country. She understood how the United States of America provided opportunity for her, both for security, for freedom and for opportunity to do what she might be able to do. And it’s something that I understood very deeply – that we have a responsibility in this country to each other, and to creating that security, for families and for the whole country, and to create that opportunity.

So as you know, I have a master’s in social work, chose to work in health care. That was my first work and went on to do significant work in women’s health care particularly. So I brought that commitment to help assure quality, responsive, accessible, affordable health care to women and children, really to all of us, to my work in politics.

BAUER: You’ve had a big story in Pennsylvania about what you’ve been able to do even from the minority side. For somebody to be able to be as full of achievement as you’ve been, and having never been in the majority party, is really one of the stories you could write one day in your autobiography.

SCHWARTZ: Well thank you, but it’s true, there’s no question what you need as a legislator, particularly as a Democrat where I was in a Republican controlled Senate for almost all of my 14 years. And we sometimes had a Democratic governor we sometimes had a Republican governor. But nonetheless, I was able to do a number of significant things on behalf of women and children in relationship to health care.

As you know, one of my proudest achievements is helping to make the children’s health insurance program happen in Pennsylvania. And as you know, that actually helped working families to be able to buy private health insurance for their kids. These are families that worked full-time jobs, don’t have health insurance themselves necessarily, or for their dependents. May work a couple of part-time jobs and do not have access to employer paid health insurance. And so it enables them to be able to do what they want to do as responsible parents, and that is to be able to buy private health insurance, either at reduced costs or really for no cost at all.

And that’s great. We have 150,000 children in Pennsylvania already covered under the CHIP program, as it’s known. And of course in Congress now I’d like to make sure that we cover all, we have access to health insurance for all American children, and do all we can achieve. And I look forward to hopefully making it happen.

But I also worked very hard to push insurance companies to cover needed women’s health services. And as one of the few women in the state Senate, the third women elected, there were just four women out of 50 when I was elected in 1990- ’91 when I began to serve. But I worked very hard to push the insurance industry to cover needed women health services – annual exams, mammography, Pap smears, injuries from domestic violence, reconstructive surgery post-mastectomy. We really did a tremendous amount of work here in Pennsylvania.

BAUER: Let me ask you a question. That is, each one of those things that women need, or particularly, female health care, is each one of those a separate bill?

SCHWARTZ: It was.

BAUER: Oh!

SCHWARTZ: Which is kind of stunning to think about, even having to do this legislatively. You think, well why hasn’t that been done? And it may well be because women were not at those tables when those decisions got made.

BAUER: How many more parts of my body need insurance?

SCHWARTZ: [laughter]. Well we did, one of the things, I wrote a piece of legislation I thought all needed women’s health services; we called it the Women’s Health Security Act. But then we knew in some ways, to get it done we had to chip away at it little by little. And that’s kind of what we’ve done.

BAUER: And this is the situation the country is in, of course, is that since we’re the only developed country that has this kind of health care, where if you have an employer then you have to see what pieces of it get into your private health care. And what you’ve done from the public side with government is that you’re working with private providers- that is, doctors don’t work for the government, they work for themselves.

SCHWARTZ: And mostly it’s insurance companies that make the decision about what’s covered or not. So the employer working with the insurance company, from the employer’s point of view they want to cover needed services, but they also need to keep the price down. So they’re often negotiating for, how can I reduce the price, the cost to my workplace? And some of the women’s health services are not part of the basic package, and that’s one of the things I’ve worked on is to make sure that women’s health service are covered in the basic package that everyone buys.

Because what happens for a lot of people is they don’t really think about the health services they need until they need them. And then when you need them, then you say, well wait a minute, that’s covered in insurance or not. And unfortunately many women were confronted with the fact that important services to them were not covered. And so part of what we’ve done is that when it’s risen to the level of, wait, we need to have our elected officials involved, that’s certainly when I led the charge in a number of ways, saying it’s really a question of fairness, it’s a question of really sharing the risks and the costs as broadly as we can so that we reduce the risk and the cost for everyone.

BAUER: And of course what you’ve talked about here then is it’s a philosophical question. That is, what do you believe in? As you said, you started with your mother’s story and your own story, and then with women’s own personal stories. That if we believe that we’re all in this life together, and that we all have different kinds of money at different times in our lives, that you’re talking about shared risk, and how did we get this information across? This is what WomenMatter is all about, as a nonpartisan information service to women, the idea of what can you do to let women know, for instance that they should sign up for CHIP, for children’s health insurance. I hear all the time that there’s more insurance available than there are people asking for it. How does that happen?

SCHWARTZ: Well for many, many people who aren’t particularly middle income, working families, they often think that there isn’t anything for them. That the initiatives that I’m talking about really apply to working families. The poorest Americans do have access to medical assistance, it’s called, but then again many of those people are working people too, and they don’t believe there is anything for them.

One of things we discovered, for example, when we started the CHIP program is that half of the people who called already were eligible for medical assistance, the national government program that’s administered by the state for poorer children and some adults, but they didn’t know it. So that is one of the reasons I believe that we ought to revive health insurance for children in particular in a way that is more universal. As we say in this country, make the political commitment that in fact every family ought to be able to be helped to find a way to get insurance for their children.

And if you said that everyone has access to it in some way, then you don’t have to spend all the money to try and tell people about it in the same way we do know. So many Americans don’t know that there are ways, through the government or the private sector, to get help for their kids or for themselves.

And the fact is, as you point out, we have not yet reached the point in this country with health care to really make sure that every American has access to health care in a way that makes sense, from a financial point of view. We do it kind of backwards. We basically say, if you have an emergency you show up in the emergency, or if you’re desperately ill, then maybe we’ll figure out a way to help you out. But if in fact you’re taking care of yourself and if you want to make sure that you get the kind of screenings and health care on an ongoing basis that will help maintain your health, we make it much harder. And so it means that we actually sometimes spend more money than we might have to. And we put people in desperate situations before we’re going to help them.

So it is a commitment that we have to make. And I believe we should do it working with the private sector. As you know from the CHIP program, we’ve worked with the private sector to get health insurance to working families. It’s not a welfare program, this is working with the private sector. The Blues, for example, Blue Cross/ Blue Shield, write it in Pennsylvania, as do other private insurers. And people want to be, that’s what they want to do and I think if we can work with the private sector to make it happen, let’s do it. And if it becomes too cumbersome or too difficult, or there are too many exclusions, then we’re going to have to do it in a different way.

BAUER: Well that’s very interesting because we’re at this point now in our country where, if you’re talking about a vision of what ought to be, everybody ought to have access, everybody ought to be able to get it, and the private sector ought to be able to make money off of it. At the same time the shared risk pool should be huge so that the sick and the well, the young and the old are all in it together so nobody’s stuck in the pool with fat smokers that have lots of small children, which causes the price to go up.

SCHWARTZ: Right.

BAUER: But for people, your constituents and the women in this country who manage at the point of service, it’s women who manage health care, so that when you’re talking in government, where does the conversation start? Does it start with cost or does it start with quality and choice?

SCHWARTZ: Well those are – different places. No question the issue of cost is a major issue. But we are increasingly talking about quality from two points of view. And that is that if we can improve the quality of care we also know that we can, for example, reduce medical errors. That’s a way of also saving dollars. So sometimes it works together and it’s assuring access to the highest quality care. But sometimes that means also reducing medical errors, catching disease earlier, getting health care to people at the most cost-efficient point as well.

BAUER: Is that something that you all in government can mandate without telling small businesses what they have to do? Because some of the small businesses are saying they want leadership from the government but they don’t want to be told they have to go bankrupt trying to fund a new idea with new employees.

SCHWARTZ: Well you point out small businesses and… let me talk about that for a minute, because one issue, I hear about health care from individuals who are concerned about it. I hear it from big companies, who are concerned about being able to pay for it and pay for our retirees. But I also hear it from small businesses, and women-owned businesses as you know are very much a part of the new economic engine and small businesses, where we’re seeing growth in the economy.

But one of the things they’re saying is, we want to be able to provide health coverage for our employees but it’s expensive. I had some of these women-owned businesses say to me, I would have hired some new employees but in fact I couldn’t afford their health insurance, and I don’t know what to do about that.

So one of the answers to that is to help small businesses be able to work together, to buy insurance as a larger group, use their purchasing power, and to be able to go to an insurance company as groups of small businesses, and be able to let them pool together through what’s know as medical associations if they want to, sort of business associations might be able to do that.

It could drive down the cost, because then you are sharing the risk. So that if one person gets sick in a business that’s got 10 people, the insurance company typically will raise their rates the next year, but if it’s one person gets sick and it’s hundreds and hundreds of people, obviously that cost is shared.

The other thing we could do is we could go to something known as community rating, where again we are not rating, the insurance companies are not rating the costs on the experience of one small business, but based on the broader community. Take Southeastern Pennsylvania. That could reduce the cost for small businesses right now. And that’s a change in the market, that’s not a change in even public dollars.

BAUER: Could government mandate a region, that you belong to a region, rather than to a poor neighborhood, or a neighborhood full of old people who are sick?

SCHWARTZ: Or a business, yes of course we could. And we should.

BAUER: Aha. So that what do you want women to do to make your job easier?

SCHWARTZ: Well I want women to be engaged in the political process. And of course by that I mean, you know, hear about the candidates, learn about the candidates. Make sure that they aren’t just saying, I care about health care too. What have they done about that? Are they looking out for the individual and the small business? Have they ever done anything to help move this forward? Look at people’s record and experience, and then get out and vote. Talk to your friends and neighbors and workmates about who you can trust to really do some work on this. I mean anyone running for office can say, I care about women too. But what have they done to advance. :

* * *

ANNOUNCER: So let’s review the facts and the trade-offs.

BAUER: Yes, what we’ve heard now is the fact that American businesses, who’ve had historically the responsibility for health care in our country since World War II, obviously can’t handle it all the way we’d done before.

We now live in a global economy and history has changed it all. So relying on big business, or relying on government to do this, in bits and pieces, we have to go back to the facts that we’ve learned through this show, listening to people who are working so hard to make it work, that every decision that’s made has trade-offs, as every other country has made them. And if we want to continue to have the best health care in the world, and we continue with our moral philosophy that everybody has a right to the best health they can get, then clearly we need to change this system which has been cobbled together. Susan, are we all entitled to the four criteria you started out talking about?

SARGENT: I’ve never seen a bigger argument or a better argument for duct tape, in terms of –

BAUER: [laughter].

SARGENT: --the variables that have to be engineered. And I know, I mean we’ve talked about the poor in different countries. My daughter just recently took a new job and had to make a decision about health insurance packages. It is not a walk in the park. It is a very difficult decisions in terms of who is she going to use, is she going to be traveling for business, what coverage does she need there?

So I think, yeah, the cost and the quality, you have to take two different perspectives – the person who’s going to use the benefits, and the person who’s going to be buying the benefits. And with all of the women businesses – and I’m proud to say that I’ve been a woman entrepreneur four times over – it is also very, very difficult in terms of how much you care for your employees and what a major asset they are, and at the same time making sure that you don’t break the bank or give away the store.

BAUER: Well let’s look then at what would happen if we take a look at the larger community. WomenMatter is asking women to come together and talk to each other about how we want to have health care work at the point of service, because that’s where we are. We’re the ones, as we said, who take not only the dogs to the vet but we’re taking the kids and our parents and ourselves to the doctor and having to deal with the hospital system.

So how much individual responsibility should we take? Or how much shared risk are we willing to have? And when listening to Congresswoman Schwartz, one of the things we’re talking about is in this country we’re not likely to go to a national health service the way the British have, where the doctors work for the government, it’s just not going to happen. We want the kinds of doctors we have that are trained in this country, with the kind of health care that the best people get.

So we’re talking about making sure that the pool is big enough. And if we decide to go with the bigger pool – and Congresswoman Schwartz suggests maybe regional pools – and we still have private insurance companies, then comes the question of how much shared risk there is within that bigger pool. If it’s a bigger pool then the young and the old and the sick and the well can be in the same pool. And as you pointed out Susan, the price per patient gets spread because there are a lot of people. So you don’t get all the sick that might overload one plan and then people get dumped out of it, or all the young people who are well who don’t bother getting insurance at all until they get sick and then end up going to the emergency room.

SARGENT: Well and I think, a couple of comments. Number one, yes, in every Congress since 1933 there’s been a proposal for national health insurance in this country. So I guess I’m kind of skeptical that it’s ever going to happen.

BAUER: Well, but the idea that, what do we want guaranteed by law? If women come together and continue to think about this together – that what the law does is to set standards – and to use our taxpayer’s dollars to make those standards work, that’s all government does.

So women of WomenMatter, what do you believe should happen? Women of WomenMatter, what are you willing to trade off? So get onto WomenMatter.com right here, go to our blog now, and tell us your story. What happens when you go to get health care? What happens when you have to make decisions about quality, waiting time, choice, and cost?

And then stay up to date on what government and the parties are trying to do. Three times a week we update this and we keep ourselves up to date. Tell your representative what you think – right from this website. And if you and your representative disagree, you know what? Find a candidate that agrees with you and support her.

This is WomenMatter, Facts and Trade-offs, and we welcome the continuing discussion among women across the country as we talk to each other and take our collective experience right to government where it might make a difference.

ANNOUNCER: WomenMatter, Facts and Trade-offs is brought to you by the Albert M. Greenfield Foundation, with support from Quita W. Horan, and the Mandell and Madeline Berman Philanthropic Foundation.