Dutch Fight to Take Health Care Away from Private Insurers

Holland-plus-medicalBrussels   What is the old saying? Something like, I’ve seen the future and it is in the Netherlands at least when we are talking about the inevitable fight to come someday in the United States to seize control of our national health care programs from big health care insurers. On the way between Germany and Belgium, I had the opportunity to meet with several organizers and campaigners who have built a powerful effort in Holland on this issue and are finding the response amazing with the potential to dominate the campaigns in the country’s elections in the spring of 2017.

If you were paying close attention during the health care debates in recent years over the Affordable Care Act or Obamacare, as it is known popularly, you often heard about the health care insurance scheme in the Netherlands which was better in its broad coverage of the population but, unlike many other countries, was provided by private, rather than public, insurers. Meeting with the organizers, I came to understand the situation a bit better. Everyone pays the equivalent of about one-hundred euros or $112 per month to private companies for insurance. I was fuzzy on exactly how this part works but the fact that they mentioned that much of the Dutch public’s opposition was rooted in disgust at the millions and millions spent by the insurers in advertising and promotion leads me to believe that a family chooses an insurer for their coverage.

There’s also a hammer to the head in this program along the lines of the deductibles that come under Obamacare. Everyone has coverage and everyone pays, but when they actually use the insurance, they have to come up with another 385 euros or $429. For some reason it is called an “own risk” payment, since if you don’t need to buy medicine or go to the doctor, your monthly payments are more like a healthcare tax or donation, so that when you do utilize the system, this is more like an admissions fee. Similar to the US experience with high deductibles blocking utilization under Obamacare, estimates are that 20% of the Dutch people are avoiding accessing the healthcare system, even when they need it, because they cannot afford the additional payment.

So the campaign is seeking to get rid of that payment of course, but also to move to a national healthcare fund more along the lines of the national healthcare program enjoyed by other countries. The support for their campaign has surpassed all expectations, and that’s part of what brought us together in this exciting conversation. In less than two months about 60,000 people have signed up to support the campaign either online or directly, and, amazingly, almost half of them are taking the additional step of asking for an “action” package on steps they can take in their communities to build the campaign.

With elections happening in mid-March of next year, this campaign couldn’t have been timed any better, so if it continues to build momentum in the summer, this could be the issue that dominates progressive debate at every level during the election. Meanwhile, regional meetings throughout the country are also pulling in crowds double, triple, and quadruple of organizers’ expectations, more are set coming off the summer with big demonstrations and other actions planned in the fall. They are riding the whirlwind here, and while they are doing so, as I said earlier, they are running the pilot program that organizers in the United States and elsewhere will need to be studying and copying in order to deal with many of the same issues involving national – and better – healthcare in our countries.

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Opportunity and Challenges in Hungary

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planning with the Civil College team

Dusseldorf   I knew just by reading the papers and some quick looks at the internet news that people and their organizations were facing severe political challenges in Hungary at the hands of a rightwing populist government, but two days of meetings with organizers and activists in Budapest left me excited about the huge opportunity our friends also have at the moment.

Mate Varga comes from a long tradition of community development in Hungary. We could almost say it is in his genes since his parents began the Civil College Foundation and he now leads the program. In recent years, he has concluded with his colleagues that they needed to embrace and support building community organizing in their country. Exchange programs and joint trainings with organizations in the United States, most importantly perhaps Virginia Organizing and Joe Szakos, its director, where one of his staff, Bernadett Sebaly spent a full-year, have given them rich experiences not only in Hungary but in Romania, Bulgaria, and Slovakia as well. Now under his leadership, they have assembled sufficient resources to support twenty-seven staff members, potentially organizers, with local and other partners all around the country.

The first day I was in Budapest, Mate and Betti, introduced me to the some of the community organizers at the Hungarian Anti-Poverty Network. We spent most of the time talking about the Hungarian workfare program currently employing, if we could call it that, 220,000 people in low level, in largely manual and menial public employment projects around the country. This is not workfare as a requirement to get welfare, but workfare is the welfare program of the state. The workfare workers are paid about $200 in USD monthly and once accepted can work up to a year and then reapply if still not able to find a job. It was unclear if it is an entitlement or there is a cap, but it seemed like an entitlement. The Network has won victories in this organizing including the payment in cash because drafts to bank accounts were forcing the workers into costly financial products. Monika Balint and I shared a number of experiences on how to handle “check” pickup days, direct actions, and benefit campaigns. The government is very proud of this program so they have widely publicized how many people are working where, so a lot of mass contact work and mobilization is elbow grease and shoe leather working the cash collection sites and job centers to meet the workers and talk to them about issues. Exciting opportunities for an organizational movement for change seemed everywhere in this workfare mess. It brought me back!

with the organizers of the Hungarian Anti-Poverty Network

with the organizers of the Hungarian Anti-Poverty Network

Speaking of movements, I also met a delightful teacher who was one of the leaders of the teachers’ movements that had put 50,000 people – a huge percentage of that workforce almost 30% – on the street in protest to government action changing curriculum, job security and about everything else in the schools. They were widely supported by parents and students. The government wisely agreed to negotiate with teachers, but they were muscled off the table by brokering groups including the unions, collected a lot of promises, and very little action. They now face the need to call for more this fall, while also trying to pull their key activists together in fifty different areas of the country where they could built local circles or chapters. Wow!

As exciting, and fraught, as both of those opportunities were, the Civil College itself was the focus of much of my time, meeting with their core team of organizers and Mate, to evaluate the best way forward in a once-in-a-lifetime opportunity they face to have the resources and potential staffing in place to assemble the pieces of a national community organization in Hungary. There was a lot of discussion of the ACORN model, because one of key pieces missing for the College team is a replicable model with the promise of sustainability since most of their external capacity is embedded in the 27 different organizations. I argued with some assistance from Chuck Hirt of the European Community Organizing Network, who had driven over from Slovakia for the meeting, that they needed to calf off a team of three to five organizers and try some pilot programs to prove what would work and share it with the others, as well as beginning now to have the conversations with groups and leaders about potential mutual campaigns and how to structure a national organization.

Heady stuff, but there is huge opportunity in Hungary, and the demand for change at the grassroots level of low-and-moderate income people with 40% of the population living in poverty is immense.

the outside of the building that has been their home

the outside of the building that has been their home

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Is Wage Theft Inevitable without a Fixed Time Clock?

BOS-Homecare-20131105-580pxNew York    Finally, it’s settled. The Supreme Court refused to hear the last gasp appeal from the industry that represents homecare employers, so it is now indisputable that homecare workers will be eligible for the minimum wage and overtime pay. This issue has been a festering sore since domestic and household workers were included in coverage under the Fair Labor Standards Act when amended in 1975 and set for full compliance in 1978-1979. We organized the Household Workers Organizing Committee in New Orleans to take advantage of the fact that they would be covered under what many of them called the “top wage,” rather than the minimum wage then.

Now, the question will be whether or not homecare workers will really receive the money, especially the overtime. Like other informal workers and even the much touted “gig” workers celebrated by techsters and others without a fixed workplace and a reliable time clock will wage theft become simply a given assumption as part of the terms and conditions of employment? The promoters endlessly flack the flexibility supposedly enjoyed by informal workers, but is this a euphemism for instability and an invitation for wage theft.

Transportation is perhaps the best example of the penalties experienced by non-workplace based workers. Over the years, the nonpayment of hours spent in transportation to various worksites by homecare workers was frequently an invaluable tactic for our unions to create leverage at the bargaining table or to punish recalcitrant homecare employers.

The FLSA has a number of advisories on how to handle transportation between your home and the central office of the employer.  It’s common knowledge that transportation time to and from your workplace is not compensable under FLSA, but when you don’t have a fixed workplace how do you calculate your hours when you are going from worksite to worksite during the day as homecare workers do or are moving from place to place on assignment as part of your job? The DOL Wage and Hour Division is clear. Essentially, once you discount the “normal” travel period back and forth between you home and the central office of the employer, the rest of the hours of travel between client locations is all compensable. For years homecare companies have tried, many times successfully, to only count the hours when a worker is with the client and walk away from their obligation by assigning three or four clients to a worker’s day spread out throughout a city and making the worker eat the travel time. The same is true if a worker’s hours would normally end at a certain time, but they have been sent to the far reaches of Los Angeles County or an outlying borough of New York or a neighboring county or parish in the metro area of any city. If rather than the usual thirty minutes of travel to home, they would have to log in another 30, 60, or 90 minutes, all of that additional time is compensable, including overtime if applicable.

I don’t see too many hands up from people who are seeing these hours paid, but the examples are numerous for any workers on the move from worksite to worksite, whether formal or informal. It would seem if you don’t have a time clock, you can assume you will experience wage theft. Why isn’t there an app for that? There are apps that tell you how many steps or miles you have walked in a day or how many calories you had for lunch or where the nearest bus stop is or how long it might take a taxi to get to you, but are you telling me that there is nothing that can verify a worker’s hours adequately to be used by both an employer and the DOL to assure that a worker is paid fairly? Certainly, there must be, but as long as it’s not in the interests of the employer to use it and DOL is powerless to enforce it, wage theft seems like it is just part of the not so hidden subsidy that lower waged workers pay to keep the companies in the service economy sitting on their shoulders and swimming freely on their sweat.

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10% is Not a Solution for Childcare Costs and Student Loans

paying-billsNew Orleans   In the last couple of days I’ve read various campaign pronouncements on capping the cost of childcare and capping student loan payments. Hey, tell me we can’t all get behind something like that.

But, I was struck by the fact that the ceiling on both of these onerous burdens for millions of working families were targeted at 10% of their annual income. Many of them are the same struggling families who are trying to raise young children, which means significant childcare costs, and pay student debts simultaneously. So even if we were capping both at a combined 20%, I started to wonder, would these families make it? Were these real reforms or a shuffling of costs on the Titanic?

So, I started looking around. Here’s the word from the Department of Labor.

The average income in the U.S., by household, was $63,784 in 2013, according to the Consumer Expenditure Survey conducted by the U.S. Bureau of Labor Statistics. Here’s how the average household budget breaks down:

Expenditure Category
Annual Average Cost
% of Budget
Housing
$10,080
16%
Transportation
9,004
14%
Taxes
7,432
12%
Utilities and Other Household Operational Costs
7,068
11%
Food
6,602
10%
Social Security Contributions, Personal Insurance and Pensions
5,528
9%
Debt Payments or Savings
5,252
8%
Healthcare
3,631
6%
Entertainment
2,564
4%
Cash Contributions
1,834
3%
Apparel and Services
1,604
3%
Education
1,138
2%
Vices
775
1%
Miscellaneous
664
1%
Personal Care
608
1%
TOTAL
63,784
100%

Childcare isn’t even on the list for the average family, so that 10% or more than $6000 that would have to come from some reductions in the list of basic household expenses. Education is on the list at 2%, though not as debt, and if fact on this hypothetically average list debt payments and savings are in the same category at 8%. In this cash crunch let’s assume the whole 8% would go to school loans and savings are put off for another sun shining day. This family would still be 2% of their income short, which now means they have to find $7200 and change to make ends meet and pay the bills, if and when this reform were ever implemented.

Drop entertainment at 4%, cash contributions at 3%, apparel and services at 3%, vice at 1%, and personal care at 1% and we get there, as long as the family can essentially wear old clothes and go to rummage sales, learn to play cards and look out the window for thrills, hold onto every spare dime and avoid the collection plate, learn to cut their own hair or take up begging on the streets and so forth. Is that a life? Is that possible? Hard to believe.

And of course there can be no rainy days in this family’s future. An emergency, a breakdown, a layoff, or a health crisis and this family goes under. Remember too that this is the average family so half of the households are even in worse shape than $63000 in annual income or may live in housing in much of urban America where 30% of annual income versus this optimistic gauge of 16% is considered a gift from heaven. We all know people now living in cities where half of their income is going for housing.

What’s my point? You could see it coming: a 10% cap doesn’t get the job done. Only the exceptions can live by such rules. In order to right size the economics of the average American family we need to see some loan forgiveness around student debts and we need some direct subsidies for family childcare. This neoliberalism, pay-as-you-go-under program has failed and is increasing the equity gap by leaps and bounds.

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The Emerging Theme of the Impotence of the Elites

Highly-secure-entrance-to-a-gated-community-in-NairobiNew Orleans   Whether regular politics or the tactics of terrorists, the common message bridging the extremes in this time of exacerbated inequity seems to be the impotence of the elites. They can take care of themselves, but the rest us are somewhere between hamburger meat and dog food.

The daily breast-beating of pundits and politicians whether on the Trump phenomena, Brexit, or any number of other standard assumptions, is gee-whiz look how badly the so-called, presumptive leaders of the world, the movers-and-shakers, the rich and well-born have climbed up in the clouds without realizing that there is no one under them and no one following them. Report after report beats the drum that there is no way any of this could have happened? Don’t they understand the consequences? Don’t they see that Trump is a buffoon or that leaving the EU would be disaster? Don’t they get it?

Seems clear that they do, and that they are sending a message as clear as a tattooed forehead, that they do get it and they don’t like it. There is no trickledown. The one-percent gets theirs and we don’t just get the hindmost, we get nada, nothing, zilch. Shut up and be happy is now being met by a message that goes something like, “oh, really, see how you like this! Hope you can sort out the mess we’re putting you in, even if you could never fix the mess you put the rest of us in.”

The muddle and mayhem seems to be catching elites on all sides in the same befuddlement. In the UK, it’s not like Labour and Jeremy Corbyn are able to seize the time, fill up the vacuum, and take advantage of the huge mistake of the Conservatives. In the USA, Hillary Clinton is sitting on a pile and some good polls, but no one, literally no one, yet sees her able to widen her lead and deliver a beat down. And, no one, literally no one, seems to be very clear exactly what Senator Sanders is up to now, so another opportunity may be turning fallow.

The same message is being sent by terrorists of the Al Qaeda and ISIS set. Hit the middle class where they are vulnerable at their favorite meeting spots, airports, coffee shops, and restaurants. The elites are secure and sequestered, but they can’t protect you. Unless you are willing to live in fear and hide in your house, you’re not safe, the government is a farce and the elites view you as nameless, faceless, fodder.

These are desperate and depressing messages for sure. Worse is that no one seems to have been really to come up with real answers yet.

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Co-Op Leaders in the Bunker, but Feeling the Heat

coversummer2016New Orleans   The cover story in this issue of the quarterly journal, Social Policy, laid out the case once again on the lack of diversity and democracy in the rural electric cooperatives in the 12-state southern area. The minimal representation of African-Americans and Hispanics is region-wide despite the huge populations of both of these groups throughout the region, frequently occupying majorities in many of the service areas of the cooperatives. The regional statistics are less than 5% representation for African-Americans and less than 1% for Hispanics. Women fare only slightly better, though they represent a majority in the South when we looked at these same 313-odd electrical cooperatives.

Cooperatives ostensibly are membership-run institutions with every member getting to vote to elect their representatives and on have a say at annual meetings on matters of policy. All of these cooperatives have been the beneficiaries of extensive grants and loans of public monies, usually federal, dating back to the New Deal, and many still are receiving discounted interest rates and loans for their programs and generating facilities. The USDA and their own literature claims they are critical economic development and social service providers in rural areas, and as a multi-billion dollar set of institutions they are a significant employer and economic presence in their service areas as well. Almost all of their websites and information includes language claiming that they do not discriminate. But, here we sit with facts and figures that undermine all of these claims and provide evidence of the opposite.

Frequently the story and the earlier report speak of these cooperatives and their leadership as “frozen in the fifties,” as if they have been able to hunker down and pretend time stopped and the civil rights movement, women’s movement and other major social changes that impact the same demographics simply never happened. Being in rural areas they have believed they could escape notice.

Being big, they can get away with it. In releasing the report to news outlets throughout the region, it was depressing talking to some of the small town weeklies and other news outlets that allegedly cover the news in these rural communities. They basically didn’t want “to rock the boat.” Many pleaded that the impact of reporting the story, even when obvious and well-known to some of them, because it was the equivalent of economic suicide: they needed the ads from the cooperatives and their leadership. We had noticed this group-think and stifling collaboration earlier when we had sent letters to all of the cooperatives and, almost defying all statistical or random possibility, we received not one single response, even a refusal to provide information or a brushoff or a go-fly-a-kite, just total silence.

Meeting with various cooperative experts and advocates while I was in Madison, Wisconsin recently, it was reassuring to find out that according to inside sources the report was on the agenda at the recent meetings of the board of the National Rural Electric Cooperative Association. One advocate speculated that there was likely not a manager of an electric cooperative in the country that had not received a copy of the report. He also believed it was likely mandatory reading increasingly for elected members of cooperative boards. All that was good to hear. They may be hiding with their heads down, but they hear the bullets whizzing by them increasingly.

If I believed in some kind of by-the-by, trickledown theory and practice of change, then I might just say, “our work is done,” and wait to see whether there might be some gradual reforms or some jump of the needle indicating more diverse representation in coming cooperative elections.

That’s not what we believe though, so to keep the heat on we are meeting today in New Orleans with our ACORN International researchers to see what the IRS 990s for the cooperative say about what these folks in the cooperative bunkers are paying themselves for directors’ fees. So far what we’re seeing isn’t pretty, but it as the cop-shows on television say, it does establish an additional motive for this kind of anti-democratic behavior which keeps the “white, right, and ready to fight” crowd running the cooperatives without real diversity or democracy, just as they have for over 75 years.

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