Health Insurance is a very important aspect for every individual. However, it is reported that the workers in Nickel and Dimed receive almost no benefits – no paid vacation or holidays, no sick or overtime pay, no retirement benefits, and no health insurance. This is certainly not a fair situation. It is argued that workers who do not receive healthcare from their employers should have increased compensation and this argument holds logic and truth at the same time.
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It can be stated that every company is responsible for the welfare of its employees and healthcare insurance certainly falls into the parameter of welfare. However, if the company is unable to pay the employee a proper healthcare or healthcare insurance facility it is the responsibility of the company to increase the compensation of the employee so that the employee can save or support a healthcare insurance.
It should be noted that under such circumstances the increase of compensation would surely not affect businesses in long term. This is because the better health of the employee would make it possible for the employee to serve the business better and in the long term, the business would surely profit from this move. Furthermore, once the health of the family members of the employee is taken care of with the help of the healthcare insurance, either paid by the employer or paid by the employee directly with increased compensation, the employee would act more freely for the company. As it is the “Average Annual Premiums for Single and Family Coverage, 1999-2008 is $14,000 and $12,680.” (SEHF, 1) That is quite a high amount.
Nevertheless, there are companies that are more ethical and moral than Nickel and Dimed and such a business is Safeway. An interview with Sebastian, Safety Chairman of Safeway, would reveal this.
What is your healthcare plan?
We provide services like Kaiser Permanente, Cobra, and Delta (just to name a few) to our employees. These are required, and costs are put into their accounts on their paycheck.
How many sick days do you get? Vacation days?
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Each employee receives 1 sick day, 3 floater days, and 2 plates per month. Employees are paid for those days, but proof is required from a professional, such as a doctor. The manager must also be informed about taking these days off (for whatever reason), otherwise the employee will get no payments.
Are you satisfied with your current working condition?
Yes, very satisfied. It’s a very safe and clean system. We try to keep the working environment as safe as possible, however there are always injuries that happen on the job. However, these injuries very rarely happen.
What would you change about your health plan? Working conditions?
No changes about the health plan. The working conditions are fine, we are always trying to practice and improve safety of our workers.
Do you have overtime pay? Do you think the amount you get is fair?
There is overtime pay, however, it is very uncommon for employees to work overtime. This is possible because some might see it as a low payment. You get overtime payments by working at other stores. The employee needs to inform the manager before going about this situation. (Interview).
However, the health coverage of the entire nation is not very encouraging at all. There are other companies like Nickel and Dimed. The decline in employer-sponsored health coverage will continue and costs of health insurance are far in excess of earnings and will continue to be so. Government intervention through public-sponsored initiatives like tax credits or health programs is sure to be hampered by large budget deficits hampering state initiatives. In some states, the growth in health care costs even outpaces state incomes. (Newfederalism, 1).
The US Census Bureau puts the number of uninsured ‘non-elderly Americans close to 46 million and this has steadily been rising since 2000. Most of the uninsured are young Americans who have not yet attained the age for Medicare. A very large of this growth is attributed to a decline in organization-sponsored health insurance. However, during a two-year period through 2003 – 04, approximately over 80 million Americans under 65 were uninsured. That means one out of 3 Americans under 65 is vulnerable to risk of bankruptcy and health hazards from being uninsured. Besides, the number of under-insured – those who have significant uncovered medical expenses- stood at more than 10 million in the year 2004. Health premiums alone rose threefold over average American incomes during the period 2000 – 04. This was largely the cause of ‘under’ insurance. A serious concern with Americans today is the possible fall out of being ill or injured in such circumstances. (CU, 1).
Most of the increase in the uninsured is due to an increase in the adult population to over 8 million equaled by a rise in the uninsured population to about six and a half million. About 4 million of this segment is below 200 percent of the poverty level. There are increases in uninsured even among the high-income bracket of the population. Moreover, the shift in employment patterns suggests a large number veering toward employment in small-size firms or self-employment. Major figures for the uninsured or underinsured are seen in this segment and most likely, the trend will continue. (Wilnskey, 1).
Economies of scale exist in the health care management industry but do not enable low premiums and ensure growth. Promotion of growth actually hampers profits, as the issue concerning us is to be able to keep servicing our corporate clients, many of whom are offloading costs to each employee. We need aggressive double-digit increases and pursue expansion of enrolments. Profits are important to the business or the general mass, as they will help survive a possible downturn caused by a low premium regime. The cumulative goal would be to achieve a premium yield of about 20%, which would help the nation outpace the cost of expansion. This would come through our corporate clients It is suggested that the nation prune down client list to include those who would be able to share these costs. Ultimately, there would be benefit from reducing the growing numbers of uninsured and passing off associated costs to those who can afford these. (Feldman, 659-670).
Growth in enrollment would probably put the nation or any business for a while in the path of unpredictable developments like rate of inclusion of new clinical technologies, which would make costs spiral. It could weather this trend as there is a mix of clients including those who came from other providers. This would be more preferable to the present trend of holding premium prices down in order to prop up business size attractive to those looking for a buy-in a company. It is also suggested that phasing out the own recent acquisitions to enable to get at true market prices.
Prevailing opinion especially after the Clinton era Health Safety Act, dictated a one size fits all policy for all customers with the same benefits. These policies would be managed by increasing primary enrollment and a scale-down of specialty utilization. The organizations followed suit by allowing maximum benefits and minimal cost-sharing with customers. There are instances where aggressively marketed policies with multiple benefits, which did not have assured customers. The marketplace has changed with organizations preferring to offload insurance costs to employees and we should now be working on a tight regimen. Fortunately, for the nation the network of physicians and employers is in place, including self-employed beneficiaries. (Vanness, 771-790).
The repositioning into the self-insured segment imposes on us the obligation to manage and maintain a consistently profitable product mix so that it too can profitably grow to serve the needs of the uninsured and provide a safety net. To continue to be stable and encourage the individual who is unable to earn a decent wage, to take up insurance beneficial to family health and life, there must be able to generate sustained profits to continue to serve social obligations. In the next three years the nation should move out from still more product lines. Recommended products should be those requiring high medical and regulatory costs. It should also ease out of most state medical programs and completely withdraw from Medicaid programs completely. The decision to direct insurance risk from the insurer to the insured may reduce our client base, but help the nation to focus efforts on a more productive range. (Feldman, 659-670).
Considering that the organizations are looking at new business models with a profit and social angle, it is obvious to look at some management options. The market is highly tiered and will need concentrated management inputs to direct and lead each niche. For some time, there might have to manage some organizational glitches owing to change on the move. As it deals with multi-category clients, there could form new management or strategic business units to exclusively deal with different levels. Profit and loss would be the responsibility of each unit with due compensation being worked into place. The whole should be backed by a management information system enabling units to report enrollments and medical claims. A separate unit would serve as a special care zone to attend to those diffident about the health care – the poor or disadvantaged. This would make the nation a more welfare state and a healthy nation.
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Feldman, Roger, Carlos Escribano, Laura Pellisé; The role of government in health insurance markets with adverse selection; Health Economics; 7, 8, 659-670; Division of Health Services Research, University of Minnesota, USA; 2006.
Vanness, David J; A structural econometric model of family valuation and choice of employer-sponsored health insurance in the United States; Health Economics; 12, 9, 771-790; John Wiley & Sons, Ltd; Division of Health Care Policy & Research, Mayo Clinic, Rochester, Minnesota, USA; 2003.
CU; The Economics of “Pay-or-Play” Mandates; Cornell University Symposium on Health Care Reform; 2006. Web.
Gail Wilensky; Poor, Sick, And Uninsured; DATAWATCH; Project HOPE Center for Health Information; Web.
SEHF; Survey of Employer Health Benefits 2008; Menlo Park, California; 2008; Web.
Newfederalism; Who are the Adult Uninsured?; newfederalism; 2000; Web.