Reforms and job changes

PhoenixRising raises a good point that has to be discussed as health care reform continues forward.  There are people who are made worse off as we reform

Um…yay? The fact that home health agencies employ a population of Americans who themselves tend to be poor, brown, low-education-level women…I’m not so sure that overall human happiness or health has improved in McAllen from this metric.

I’m happy that fewer old folks are getting operations they didn’t need, which is the main cost curve effect described in the article. That’s good. Destroying a poorly functioning market in home health care, in which federal dollars were being transferred to some poor folks to make other poor folks less miserable, isn’t the same thing.

People delivering unneccessary services are not seeing that their services are either non-productive or counter-productive as they are working their asses off for their paycheck.  They are seeing their paycheck disappear.  And given our current political climate, they might be lucky to get twenty weeks of unemployment insurance at best and told good luck.  They are not being compensated for their losses even as society as a whole is better off.

In any significant service delivery reform model in the United States, there will be employment shifts.  We should expect to see employment shift from specialty care to primary care, we should see employment shift from hospital floor services to “softer” services like care coordination and care education roles, we should see fewer MRI technicians hired but more senior care checkers, we should see fewer back surgeries performed but more phyiscal therapy hours billed.  We should see more master level clinicians, we should see more LPNs, we should see significant employment gains but at the same time everyone employed in healthcare today won’t have that same job in the future.  There will be significant displacement.






10 replies
  1. 1
    satby says:

    Displacement always sux, the specific problem with home health care workers is that these are workers with almost no other avenues for employment. And that’s the real issue, that we throw away an entire subset of our population, wasting their skills or preventing them from developing any to begin with.

  2. 2
    Baud says:

    Lots of things cause displacement. That’s why liberals tend to support a strong social welfare system, because we don’t blame workers like conservatives do.

  3. 3
    satby says:

    @Baud: Agree. And we favor things like good public education and services that would allow people to develop skills to have more choices in their lives other than working menial, poorly paid but essential work.

  4. 4

    We should expect to see employment shift from specialty care to primary care

    Thank Celestia. I feel bad for everyone caught in the middle, but the old system was hurting even more people.

  5. 5
    Another Holocene Human says:

    Basically labor has no power (witness the massive court loss for home health aides attempting to organize in Chicago) so there was no power to negotiate a cash-out. That’s the sorry truth.

    Wanna blame somebody? Stop badmouthing Obama (who has been trying to get pay increases for home health aides for fuck’s sake) and look at your family, friends, and coworkers who have a kneejerk labor/unions/workers bad reaction to anything having to do with hours, wages, and working conditions for any worker except, of course, themselves.

    In that environment, the bad actor firms rule ….

  6. 6
    WereBear says:

    If what went under was predatory employment agencies, perhaps a better system could rise from the ashes.

    Fact is, home health care is a huge potential market: it lets seniors age in place while saving money on institutions, it’s a demanding job that does require skills, and figuring out a way of taking care of our seniors while offering dignified jobs at living wages should be the goal.

  7. 7
    PhoenixRising says:

    @WereBear: Exactly.

    Some of the displaced workers (G-d willing) are going to be the paper-pushers who run me through an obstacle course on every visit to the oncologist.

    When we’re down to 2 ‘private, non-profit’ carriers in my state, I’m guessing that there will be only one person checking my coverage at each visit, not 3 who are using 3 software systems to track different things about my insurance (co-pay, coverage limits, standards of care for my DX, etc.)

    And that will be great. Those people can work in cell phone store, or at the gas company, or in the back office of a propane delivery service, doing the same tasks, because they aren’t making my treatment easier on me or delivering data to my doc–they are serving the system itself.

    There is a difference between that work, which meets the needs of a kludged-up health care system, and the home health aides who make sure my 94-year-old neighbor gets bathed every day and clean sheets every week.

    Again, I’d prefer a system of cash transfer in which his granddaughter could afford to live in his home while finishing her masters’ degree…but I live in Albuquerque, not Amsterdam, so…

    Home health care is a fast-growing sector of employment for the least-educated Americans because of demographics, and how to fairly offset the impact of reform on those workers is a real problem.

  8. 8
    boatboy_srq says:

    @satby: There’s also the issue that HHWs may not be paid particularly well, but their employers (who are generally home health providers and not the individual elderly clients) charge rates that mask that. The fee-to-salary proportions are not incomparable with other “temporary” employment: rations of 2/1 or 2.25/1 are not uncommon. And in this market, since the clientele are largely on some variety of fixed income, there’s very strong pressure to keep the costs down – which in turn keeps the wages suppressed. Agencies exist because liability is more easily accounted – and cheaper for an enterprise than a sole-proprietor – and because the agencies are theoretically screening their staff (not that it happens much but the theoretical protection is there), so there’s an assumption that an agency-supplied HHW will be more ethical and less abusive than a privately-contracted individual – and if not that the agency will be able to compensate properly.

  9. 9
    boatboy_srq says:

    @PhoenixRising:

    There is a difference between that work, which meets the needs of a kludged-up health care system, and the home health aides who make sure my 94-year-old neighbor gets bathed every day and clean sheets every week…

    Home health care is a fast-growing sector of employment for the least-educated Americans because of demographics, and how to fairly offset the impact of reform on those workers is a real problem.

    I’ve spent my time as in-home caregiver for a family member and as the wage-earner paying for a HHW to replace me in the home while I was on the job. Unless you’re talking about places where professionals are valued and decently compensated, you’re talking about situations where a working professional’s take home pay is going ~100% to the home health aide replacement’s fees. That’s now, and that’s with the crummy wages HHWs are currently getting. We need to find a way to get HHWs better pay, but still keep the consumer cost low enough to be practically payable.

  10. 10
    RSA says:

    @boatboy_srq:

    Agencies exist because…

    Another reason is that not all home healthcare gigs are full time; an agency can spread work among its contractors, so that each can piece together a schedule more easily than directly with clients. In theory, at least. I’ve found it helpful to have an agency because my own schedule changes, and I’ve sometimes needed to have someone come in at irregular times, which our regular caregiver couldn’t manage but the agency could arrange with a substitute.

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