interviews
Labor and the White House
by Dave Weigel
March 31, 2021
This interview with Dave Weigel, national reporter covering politics for the Washington Post, was conducted and condensed by franknews and Payday Report.
DW | The White House's involvement in the Amazon union drive was a big surprise. I mean, we know where it could have originated, the union talked to the White House; they have kind of an open door with Biden that they didn't have with Trump. We know that Faiz Shakir, Bernie Sanders’ campaign chairman, and his group, Perfect Union, got involved. So, there was public pressure.
The fact that the White House and the president released that video was a big deal to people. And, he made this decision to get involved very early on in his presidency. It was within his first 50 days. He decided to do what hadn't been done before and give a message in support of the union. It was a very careful message. The new labor secretary, Marty Walsh, when asked specifically about Amazon, responded in more general tones.
But, no matter what happens, if you are in for a penny, you are in for a pound.
A lot of previous presidents, including Barack Obama, said a lot less about these union drives and, in doing so, limited their own exposure. If the drive didn't work, people didn't say that the president supported something that didn't work. The fact that Biden made a statement, early on, when it wasn't clear how this was going to go, is a real political statement of what they thought was important.
frank | How do you think his background plays a role in this?
He's always leaned in really hard and identified with workers in the same way he's tried to identify with different civil rights movements. Joe Biden has always wanted to be seen as the kind of person who is coming from Scranton, who has lived through the sixties, and who wants to jump to the front of the march if there is a struggle happening.
He frames everything in terms of fairness. He's not as natural as other members of the party in talking about this. When Bernie Sanders talks about this, for example, he talks about greed, he names CEOs, he says nobody deserves that much money, he talks about a maximum wage and how there should be no billionaires at all. Biden doesn't go that far. Biden has never gone after Jeff Bezos. He's never gone after individual heads of companies the way that Sanders does. He does this sort of a "Hey man, these guys are under assault, somebody needs to stick up for them."
That is something that he has always wanted to be part of his brand. Even when he was voting for trade deals like NAFTA as a Senator, he was never really comfortable. He had the same ideological mindset as a lot of the Democrats in the eighties and the nineties. He did it because he saw that that was the way things were moving and he voted strategically. But, the stuff that fired him up was when he could side with workers. It is the same thing with the projects he took on under Obama when he was Vice President.
During the Democratic primary, he didn't get the same amount of labor support that Hillary Clinton did, but, Sanders didn't get it either. There wasn't the same sort of a landslide of labor to get in early and say, this is our candidate. Instead, they were demanding more of the candidates.
I would cover presidential primary events with the Teamsters in Cedar Rapids or the Building Trades in DC and you would kind of look to the level of applause as an indicator. The interesting thing is that at those events Sanders would lay out the things he did and what he wanted to pass. Biden would go on at length about non-compete clauses and about wage theft and things like that. It was less, "I have studied all of the papers on this and I've decided this is my policy," and more of "this seems unfair and I'm against this thing."
I think the Democratic Party is increasingly understanding what labor can mean for them strategically.
Republicans have gotten kind of tangled up on labor. They have done better with union households, but they are basically the party of deregulation still. They've never really moved on the labor part of their messaging. That makes it easier for Biden to compete for these workers. When it comes down to it, Republicans want “right-to-work." Josh Hawley, who branded himself as a working-class candidate, for example, supports a national right-to-work.
Biden was very concerned with winning back more union households. Union workers were saying, “Democrats had the presidency for 16 years. What do they do for us?” Biden didn't have all the answers that labor wanted, but he was making a lot of specific promises about how he was going to act. He talked about infrastructure spending and about how he was going to run the NLRB and how he was going to approach employers. It was less than Sanders did, but that's way more than Democrats had done in the past.
I mean, the McCain/Romney era Republicans had no appeal to the sort of voters who voted for Obama twice and then voted for Trump. Biden only peeled back maybe 10% of them depending on where you're talking about, but it has made life easier for Democrats.
This fight has in large part been framed in the context of continuing a battle for civil rights. Do you see Biden lean into that messaging?
Biden did not really lean to the racial justice aspect or the civil rights legacy aspect of this labor fight. When the congressional delegation here came down a couple of weeks before the vote, they were much more explicit. Someone like Jamal Bowman or Cori Bush is much more comfortable saying that than Biden. That is the thing about Biden. He basically sets boundaries. He says what his position is and backs off and lets the action happen without his constant commentary. It's very different than Trump in that way too. And that's different than the Sanders position. And it's different than what Warren said her position would be as president.
Can you give us context on how or why you started covering this story?
I started covering the Amazon drive because of the president and members of Congress intervening. I mean, labor decided to get involved months before, but the fact that Democrats were getting involved was new. It has been interesting to monitor their investment in this over other Democratic Party causes.
There's a little bit of intervention from the Democrats, but not, I'd say equal to what Amazon is doing. They are not the advertisements on TV. We all know the Democratic party is kind of involved, but it is not the same political project that I've seen in other places.
There are two stories that kind of were happening at the same time; they have merged, but not completely. One is this labor drive, which is smaller than most drives that have succeeded. It is not overwhelming. You don't see labor signs everywhere you go. But, on the other hand, the level of national involvement is kind of new.
Had Biden said nothing, there would have been a story, but it wouldn't involve the White House, it wouldn't involve the Democratic Party, and it might not involve the PRO Act.
And I think that's going to change because of this.
New interview w/ @daveweigel @PaydayReport
— frank news (@FrankNewsUS) April 6, 2021
"The White House's involvement with the Amazon drive was a big surprise ... Previous presidents, Obama comes to mind, said a lot less. The fact that Biden did that early on is a political statement of what they thought was important." pic.twitter.com/MwYlmqE4xQ
That was a big decision Biden made to be a part of this.
Right. And that political story is interesting. The story here is much more independent. A lot of the people who've come in to help canvas are from smaller groups. You have Black Lives Matter and DSA groups from the area, but you don't have the Democratic Party getting involved in a huge way. I think that is something that people will revisit after the vote.
Should the Democratic Party, like most left parties in the world, be very involved with labor? Should they always take the side of labor?
Most social democratic parties are labor parties and they build up from there. Their coalition includes labor unions. In the British Labour Party, for example, labor has a role in electing the leadership. That is not the case here. That's the conversation I think they're going to start having when this votes over. For example, if there are, and the union says there are, hundreds of people around the country calling them saying, "Hey, I have some questions about what I can do at my fulfillment center in my town," that will be a question for Democrats.
And if Amazon wins, do you get spooked? Amazon has been very punchy in their PR. They might say that a bunch of elite Democrats stood with the union and the workers stood with Amazon. That is very comfortable turf for Amazon to be on, and that leaves a big question open for Democrats. If the union succeeds, throw all of that out the window. I think the lesson that everyone would take in that case would be that if it takes less than a three-minute video from the president to get momentum for something like this, then we should keep doing that. As we talk, I don't know the answer to that question. I think that is something that is going to be answered when the votes are in.
interviews
The Cost of Care
by Sara Collins
September 23, 2020
This interview with Sara Collins, vice president for health care coverage and access at The Commonwealth Fund, was conducted and condensed by franknews.
Sara | I lead the healthcare coverage and access program at the Commonwealth Fund. I also lead the tracking health system performance initiative, which is a research initiative that tracks state by state performance on a variety of measures.
We just released a report on health insurance coverage in the United States based on a survey we do every other year. In addition to looking at how many people were insured, we created a metric to examine how many people are underinsured. We define underinsured as those whose out-of-pocket costs are equal to 10% or more of their income, 5% if they have lower-incomes, or if their deductible is 5% or more of their income. Our goal is to look at how many people are exposed to high out-of-pocket costs relative to their incomes. How many people are insured all year, but have such high out-of-pocket costs and deductibles as a share of their income that they are effectively uninsured?
frank | Can you lay out the landscape of your findings regarding healthcare and affordability?
In our biennial survey that we have conducted since 2001, we asked working-age adults if they have had difficulty paying their medical bills. Over time, we have seen growth in the share of people who had any problem in paying their medical bills. That includes those who are not able to pay their medical bills, those who were contacted by a collection agency for unpaid medical bills, or those who have to change their way of life in order to pay the bills or were paying off medical debts over time.
Since we started, there has been a gradual trend upward in the share of people reporting any one of those problems. It peaked at about 41% in 2012, and then as more people got health insurance with the passage of the Affordable Care Act, we saw a slight decline. But the percentage of people never really fell that much.
The rates are the highest among people who are uninsured or were uninsured anytime over the past year. About half the people who were underinsured reported problems paying their medical bills.
What sort of long term implications do these medical bills have?
This has implications for the rest of people's lives. In our survey we asked if they were having other financial problems because of medical bills, including using up all their savings, receiving a low credit rating, taking out credit card debt, or being unable to pay for basic necessities.
We can see that there are significant lingering financial implications for those with medical bills.
What explains the increase you have been seeing over the last decade?
Over the last decade, people's incomes haven't grown very much, but their out-of-pocket cost exposure has grown and their deductibles have grown.
If you are getting coverage through an employer, which is where half of the working-age population gets their benefits, in most years the cost of your premiums is rising. Premiums are driven by health care costs. People are having to contribute more towards their premiums, and they are seeing increases in the amount they have to pay out of pocket in copays when they get healthcare. And incomes are not rising very quickly as people make wage concessions to receive their healthcare.
Why are premium costs so high? Does it accurately reflect the cost of providing assistance on the part of providers?
In private insurance, much of the growth we are seeing in premiums comes from growth in the prices that are paid to hospitals and other providers. Prices vary significantly across the country. There's no consistent pattern. Provider prices generally have very little relationship to the actual cost of healthcare. They're determined by local market conditions.
Providers that have a lot of leverage in markets are able to increase their prices. In other product markets, the cost of production drives the price of a good, but healthcare is different.
Why don't we see that significant of a fall with ACA?
The ACA made critical changes in the individual market. It made sure that people were able to get a plan, and that those with preexisting conditions were able to get a plan. The subsidies from the ACA were also important in enabling people with lower incomes to get coverage.
But the trend in private coverage, the trend of rising premiums and wage stagnation, has continued, and that affects individual markets too. It covers people but still exposes many people to high out of pocket costs. Deductibles are taking up a larger percentage of people's income.
What sort of healthcare reform could drive lower costs?
The primary value of both a public option and a single-payer approach is the ability to leverage down the primary drivers of healthcare costs.
And think about what I mentioned about what's driving premiums -- and that is the prices that providers are paid in commercial insurance. A public option provides the federal government with some leverage to negotiate those prices down close to Medicare prices. The cost of covering everyone could be lower with a public option or with a Medicare for all approach.
How do costs and the threat of debt affect people's willingness to seek care?
On the same survey, we asked a set of questions about delaying care because of cost. About 56% of people who were uninsured anytime answered yes, and about 43% of people who were underinsured answered yes.
Out of pocket costs are leading people to make decisions that are not in the best interests of their health. It's a significant issue and the pandemic has shone a bright light on the dangers of having high out of pocket costs that lead people to decide against getting the care they need to stay healthy.