A Philosopher's Blog

Adjuncts & the Affordable Care Act

Posted in Business, Philosophy, Politics, Universities & Colleges by Michael LaBossiere on January 7, 2013
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The Affordable Care Act imposes fines on large employers (defined as those employing 51+ people full time) that fail to offer affordable insurance coverage to their full-time employees. As might be imagined, this has created some concerns for such employers and their employees.

While I do believe that the act has some positive aspects, I tend to agree with those who think that health insurance should be split from employment. That is, it should be something people can select from a competitive market regardless of who they are working for. Properly done, this would be a considerable benefit to businesses and individuals.  However, my main concern here is with the likely impact of the Act on adjuncts and others in a similar plight.

Adjuncts are, in many ways, the temp workers of academics. They are typically hired from semester to semester to teach a few classes at relatively low pay ($1,500-3,000 per class being typical) and generally have no benefits or job security.  Adjuncts are usually classified as part-time employees, primarily because they often teach less than what is considered a full class load and typically do not have the other duties (such as committee work or advising) of full-time faculty. They are also typically classified as part-time so as to avoid the need to provide them with the benefits of full-time employees.

The Affordable Care Act defines a full-time employee as one who is employed an average of thirty hours a week.  Currently, there is not a clear definition of how the part-time status of adjuncts should be determined, since adjuncts typically work in terms of credit hours taught rather than in terms of hours on the clock.

As might be suspected, colleges, universities and businesses have varied definitions of what counts as being part-time and not all of these match the Affordable Care Act definition. In response, some colleges and universities are already taking steps to address this matter. A common responses has been to cut the hours of adjuncts and other part-time workers to 29 hours or less to avoid having to provide affordable insurance or paying the fine.  In the case of adjuncts, some schools have cut the number of courses and adjunct can teach, despite the fact that the matter of what counts as full time faculty under the act has not been sorted out.

As might be guessed, the reduction in hours is an unintended consequence of the act. However, it is obviously not good for the adjuncts and other part-time employees who are typically struggling to get as much work as they can. As it stands, adjuncts often have to teach classes at multiple colleges in order to get by and other part-time workers often have to hold multiple jobs. If employers start reducing the hours of part-time workers, they will need to find additional jobs to make up for the lost income, which will be at least inconvenient.

On the one hand, it is easy to blame the Affordable Care Act (or, to avoid the fallacy of reification, the people who passed the act). After all, the “big” employers are being forced into a trilemma: provide affordable health care or pay fines or cut employee hours down to 29 hours a week or less. Since the first two options cost money, the obvious choice is the third one. No doubt employers would prefer to keep things as they are, but the act forces them to make the employees pay the price for the act.

On the other hand, it could be argued that the employers deserve some of the blame, especially in the case of colleges and universities. After all, adjuncts are exploited by universities and do not even get the insurance coverage that is offered to students (I had better benefits as a grad student than as an adjunct). Adjuncts could be provided with affordable health care (as students are) it is just the case that employers are choosing not to do so in order to save some money. That is, it is just another case of the working people being screwed over by those with vastly larger salaries and plenty of benefits. It is not surprising that many of the same folks who weep over the rich being forced to pay marginally more taxes are also outraged that businesses would have to provide affordable health insurance to employees. There is also a certain meanness in the attitude that is essentially this: “What, we have to provide full-time employees with affordable health insurance or pay fines!? In that case, we’ll just fire people or cut their hours!”

My own view is that this illustrates the important of separating health insurance from employment. This would allow employers to hire people without worrying about the costs of providing insurance (or paying fines) and would allow individuals to get insurance apart from being employed. Of course, this would require serious revisions to the health insurance industry to make health care actually affordable for individuals, especially those working low-paying part time jobs. Naturally, employers could continue to offer health insurance, but this would not be mandatory. However, no matter what is done, someone obviously has to pay the bills.

 

 

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The Individual Mandate

Posted in Ethics, Medicine/Health, Philosophy, Politics by Michael LaBossiere on April 2, 2012
United States Supreme Court building in Washin...

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The United States Supreme Court is considering the constitutionality of the Affordable Care Act and this has created quite a political stir. One of the main points of concern is the individual mandate. The gist of this is that individuals are required to buy health insurance. Those who fail to do so will be fined.

Setting aside the rabid rhetoric, the main philosophical issue seems to be whether or not the state has a legitimate right to impose this mandate. Or, as opponents of the mandate put it, whether or not the state has the right to require people to buy a private product.

On the face of it, I am inclined to agree that the state does not have a general right to compel citizens to buy products even when it would be wise and good to do so. As critics have noted, while broccoli is good for people, the state would seem to have no legitimate right to compel people to buy it. This sort of reasoning is consistent with my own view of liberty, which is roughly based on that of John Stuart Mill’s view. The general idea is that people only have a moral right to compel people when the actions in question can cause unwarranted harm to others. Even if doing something would be good or wise, society has no right to compel an individual into doing (or not doing something) when it is not their legitimate concern (that is, involves harm to others).

Because of my adherence to this view of liberty, I would be against the state compelling people to buy broccoli, to exercise or to quit smoking. After all, in such matters the individual is sovereign. Since I endeavor to be consistent in my principles, I also oppose the illegality of recreational drugs as well as any law that would ban same-sex marriage. After all, if it would violate liberty to force someone to buy broccoli because it is good for them, it would also seem to violate liberty to force someone to forgo marijuana because it is bad for them or to forgo same sex marriage because some people do not like it. Not surprisingly, some folks are not quite consistent in these matters: they scream for freedom when an individual mandate is on the line but are quite happy to impose on others when the issue turns to same-sex marriage.

Given my view on a broccoli mandate it might be suspected I would oppose the individual mandate.  However, this is not the case-I actually support it. Naturally, some folks might accuse me of supporting it from blind liberalism. However, my reasons for supporting it are classic conservatism. This should not be at all shocking since the individual mandate actually has a fine conservative pedigree.

Given its origin, it might be tempting to argue that the conservative assault on the mandate is misguided. However, to claim that something is good (or bad) based on its origin would be an error (specifically the genetic fallacy). It might also be tempting to argue that the conservatives are being inconsistent in attacking the mandate given that it was supported by conservatives in the past. However, this would be a mere ad hominem tu quoque.  However, it is certainly interesting to note that the conservative opposition to the mandate seems to be driven by their opposition to Obama rather than the result of a reasoned repudiation of the conservative arguments in favor of the mandate. As such, one might suspect that the rejection of the mandate is motivated in part by an ad homimen attack amounting to “Obama and the Democrats are for it, so it must be bad.” However, my goal is not to consider the history and psychology of the matter, but to present conservative arguments for the mandate.

One stock conservative principle is that people should take responsibility for themselves. This principle is often taken to entail more specific principles, such as the one that people should pay for what they receive and the one that the state should always endeavor to avoid providing welfare and its ilk.

These principles seem eminently reasonable. After all, if I fail to take responsibility and because of this I get aid from the state that I have not paid for, it would seem reasonable to regard me as a thief. To use a specific example, if I decide that I am tired of working and quit my job to go on welfare, then I would seem to be stealing from my fellows. After all, I could support myself and merely would have chosen not to do so. To use another example, if my company gets subsidies from the state when it is profitable on its own, I would thus seem to be robbing my fellows. After all, my company can easily support itself without sponging off the taxpayers.

At this point, one might be wondering what these principles have to do with the individual mandate. After all, it has been cast as the state imposing on liberty by forcing people to buy a product. However, this is not the proper way to see the mandate. To see that this is the case, consider the following.

Back in 1986 the United States Congress passed the  Emergency Medical Treatment and Labor Act. This act mandates that hospitals cannot turn away or transfer a patient unnecessarily when there is an emergency condition. While hospitals can ask about the patient’s ability to pay, they cannot delay or refuse treatment based on a lack of ability to pay. Hospitals can, of course, refuse to provide treatment or examination in non-emergency situations. Hospitals that violate the law can be fined as can doctors who are complicit in declaring a patient’s condition to be a non-emergency when it actually was.

Since people know that hospitals cannot turn away emergency cases, people who do not have insurance often turn to emergency rooms for medical treatment. In some cases, they do so even for routine care on the assumption that the medical personnel will provide at least some care even in the case of non-emergencies. While there has been some dispute over the exact numbers, this has been a problem in many hospitals for quite some time.

Obviously enough, when a hospital provides “free” medical care to the uninsured, it still must be paid for. After all, medical personnel do not work for free nor do the supplies and equipment needed for treatment come free. While hospitals do try to collect from the uninsured patients, this often does not cover the bill. After all, most people who are uninsured are without insurance because they cannot afford it  rather than as a matter of choosing to forgo it. As such, the costs must be passed on to those who have insurance as well as on to the state. It is estimated that covering the bills of the uninsured adds $1500 to a family’s insurance premiums and about $500 to that of an individual.

As such, under the current system hospitals are required to provide services to those who cannot pay and the insured and the taxpayers are compelled to pay the bill. Thus, some people are not taking responsibility by paying for what they receive and others are left to pick up the tab-including the state. This is exactly the sort of situation that one would expect a conservative to rail against. After all, it involves people getting something for nothing as well as other people being compelled to pay more. And, of course, it also involves the state in providing “handouts.”

In this situation, there seem to be two main legitimate conservative options. The first is to ensure an end to the free ride and the government handouts by compelling people to get insurance. This way they would be paying for what they received and not being free riders. This, coupled with the Affordable Care Act,  would also have the benefit of allowing people affordable access to non-emergency preventative care which would be better for their health and also reduce the strain on emergency rooms. There is, however, a second option.

A second way to address this problem is to repeal the part of the  Emergency Medical Treatment and Labor Act that requires hospitals to provide emergency care to people who cannot pay. If those without insurance or money were not treated, then there would be no extra cost to pass on to the insured or to the state, thus solving the problem at hand.

Obviously, while the second solution would save some people money, it would not come without a price. It would require accepting that people should be left to die if they lack the financial resources to pay for vastly overpriced medical care. I would certainly hope that this is not a value that my fellow Americans would endorse, but perhaps this is not the case. Perhaps we should be free of the burden of caring for others and they should be free to die on the curb of a hospital because the job creators did not create an adequate  job for them.

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Protect Life Act

Posted in Ethics, Law, Medicine/Health, Philosophy, Politics by Michael LaBossiere on October 16, 2011
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Abortion is a matter of seemingly endless moral and political debate. In the latest round, the Republican controlled House has passed the Protect Life Act. Two of the main aspects of the act include preventing federal money from being used in health care plans that cover abortion and to allow health care workers to refuse to perform abortions. This includes cases in which an abortion is medically necessary to save a woman’s life.

The first aspect of the act seems to be at least partially a solution in search of a problem. The Affordable Care Act (known by the dysphemism “Obamacare”) already prevents public money separate from private insurance payments covering abortion. However, the is a common misconception (intentionally fueled) that “Obamacare” pays for abortions.

The act goes beyond this in an attempt to restrict coverage of abortion. The bill, if made into a law, would forbid women from buying private insurance plans including abortion coverage. This is, of course, limited to purchases made through a state health care exchange.

The main justification for this aspect of the bill is that the Republican backers claim that taxpayer dollars should not go to abortions. Of course, the bill goes beyond that and attempts to restrict women’s choices.

On the face of it, the justification has a certain appeal. After all, in a democratic (or republican) system, the taxpayers have a right to decide where their tax dollars are spent (and also to have a role in decisions in general-if only via representatives). As such, if the majority of Americans are opposed to having tax dollars go to abortion, then it would be presumably correct to not provide such funding. Majority rule and all that would serve as the moral justification. This would, of course, entail that the same principle should apply uniformly. So, for example, if the citizens did not want subsidies going to corporations or did not want to fun capital punishment, then such things should not be allowed.

In the case of abortion, most Americans hold that it should be legal. While this does not entail that they want to fund abortions, it would seem to indicate that abortion rights are accepted by the majority of Americans. As such, attempting to restrict these rights under the guise of keeping taxpayer money from funding abortion would seem to be somewhat deceptive. After all, it is one thing to prevent public money from being used and it is quite another to forbid women from buying private insurance with their own money. It is especially ironic given the Republican mantras about the free market and individual choice.

Also, if most Americans favor the legality of abortion and the Republican backers of the bill are claiming that they are right to impose restrictions based on the fact that some people are morally opposed to abortion, then it would seem to follow that anything that is morally opposed should not be funded. This would include capital punishment, war, the drug war and so on. In fact, it seems likely that very little would be left with public funding. Naturally, it could be argued that the moral opposition would need to be significant, but even under that condition capital punishment and many other things could no longer be funded with public money. Perhaps this would be a good thing-but I am reasonable sure that neither the Democrats nor the Republicans would be willing to accept this a general principle.

Perhaps the most controversial component of the bill is that health care workers who morally oppose abortion will have the legal right to refuse to perform abortions-even when doing so is medically necessary to prevent the death of the woman. Currently hospitals are legally required to perform abortions when doing so is medically necessary to saving the life of the woman.  Some Catholic hospitals have been breaking the existing law for years.

On the one hand, a strong case can be made for allowing health care workers to decline performing an abortion on moral grounds. After all, a law that compels people to perform what they regard as an immoral action (such as fighting in war or paying taxes to support a war or what they regard as an unjust system) would seem to be well worth both moral and legal scrutiny. This matter has, of course, been addressed in regards to civil disobedience and the question of what a person should do when his/her conscience conflicts with the laws of the state.

In the case of non-emergency procedures, I am certainly sympathetic to the view that health care workers with strong moral beliefs should not be forced to engage in what they regard as an immoral action (most likely murder). Likewise, I am sympathetic to people who refuse to fight in war or support the state on the grounds that they regard the killing  (or murder) of human beings as immoral.

On the other hand, a strong case can be made that professionals are obligated to perform their jobs even when doing so goes against their conscience. For example, a nurse who is opposed to drug use would not seem to have the right to refuse to treat a victim of a self-inflicted drug overdose of illegal drugs. As another example, a police officer who thinks that homosexuality is an abomination would not seem to have the right to refuse to protect a homosexual who is being beaten to death.

In the case of emergency procedures, a very strong case can be made that such procedures should be performed. On utilitarian grounds, performing such procedures would seem to be right. After all, the most likely result of not performing the procedure is that the woman and the fetus both die. The procedure would at least save the life of one person, which would presumably be a good action. To use an analogy, imagine that a child has been rigged with a terrorist bomb and is running at a woman. The bomb cannot be removed in time and will detonate in seconds. A soldier or police officer is nearby and can stop the child-but only by shooting her. The woman can, of course, scream to the soldier/officer that she would rather die with her child. However, it would not seem wicked of the soldier or officer to take the shot if the woman did not forbid it.

It can, of course, be argued that this is not a utilitarian matter but a matter of the action itself being right or wrong. If it is assumed that abortion is wrong because it is killing, it would seem to follow that not helping the woman would also be wrong-after all, this would cause her death.

At this point it is natural to bring up the stock distinction between killing and letting die. In the case of the woman, the medical care provider would be letting her die rather than killing the other being (which may or may not be a person). In general, our moral intuitions tend to indicate that killing is worse than letting die, which could be taken as a point in favor of allowing health care providers to let women die rather than perform an abortion. However, since the being will also die anyway (in most cases) it would seem that refusing to save the woman would (as noted above) merely double the number of deaths rather than do something that would be morally commendable. This could even be argued on the same moral basis as triage. In this case, the act could be seen not as killing the being, but saving the mother rather than allowing two patients to die. To use an analogy, if a mother and child were brought to a hospital and both were dying and the doctor knew that her choice was between saving the mother or letting both die while she worked to futilely save the child, then the right thing to do would seem to be to save the mother. Expending pointless effort on a child that could not be saved while letting the mother die would not be noble or good. Rather it would be a wrongful decision that would kill the mother.  As such, this provision is clearly immoral.

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