Thursday, April 22, 2004

I Seem To Have Touched A Nerve. And Had One Touched.

Kevin Drum linked to my story about Wal-Mart, sending several thousand visitors my way. A whole lot of additional commentary followed.

I guess I've been spoiled here in my little corner of obscurity. I was taken aback by the ugliness of some of the comments that followed, like the guy who apparently thought that maybe my client would have plenty of money to buy HIV care out-of-pocket if she weren't spending her huge Wal-Mart salary on Manolo Blahniks, and the guy in Oliver Willis's comments section who thought that "the story here is the woman who screwed up, not the private corporation who decided not to punish its responsible employees and consumers by taking money out of their pockets to bail her and others like her out - quite possibly so they can go out in the world and be irresponsible some more." In fact, several people seemed to think that providing adequate health care to people with HIV would only encourage bad behavior.

I know, I know - I shouldn't take this stuff personally. But it turns out that it's very hard for me to hear people saying unwarranted nasty things about my clients. This woman's an economic or moral abstraction to them, but I sat in a room with her for an hour and heard about all the miseries of her life. It's my job to help her and care about her. So I feel protective of her, and now I'm sorry I exposed her - even anonymously - to scorn and condemnation. I'll think twice before I post anything else about my clinical work here.

Moving on to Wal-Mart's defenders: I'm perplexed to see anyone make the argument that "you'd think Wal-Mart had given this woman AIDS. (They didn't.) So why does Wal-Mart owe her payment for her treatments, in addition to her regular wages? And if I'm her co-worker, and I don't have HIV, why should she be paid more than me?" I'm guessing that this person must be opposed to the whole concept of employer-provided health coverage. (I wonder who pays for his medical care.) After all, my employer didn't give me allergies or hip dysplasia, and they didn't give my Significant Otter high cholesterol. When I fell down the stairs, I wasn't pushed by my boss. Why should they pay for any of the medical visits or treatments related to these various problems? And shouldn't the person who works in the next office be jealous that I got my salary AND some X-rays, and she just got her salary?

Predictably, lots of people argued that Wal-Mart would inevitably have to either cut staffing or raise prices in order to provide adequate health coverage to its employees. None of the folks on the pro-Wal-Mart side seemed willing to consider the possibility of shareholders accepting reduced profits in order to provide employees with adequate salaries and benefits. It turns out that people who are quick to scorn the idea that corporations have any moral obligations to their employees are simultaneously very protective of the moral obligation corporations have to maximize shareholder value. (Check out this criticism of Costco, which does pay a living wage, from Deutsche Bank analyst Bill Dreher: "Costco continues to be a company that is better at serving the club member and employee than the shareholder." I think I'll talk about Costco in a separate post.)

Finally, lots of people (and I wonder who pays for their medical care) wanted to know why I thought Wal-Mart had any obligation to provide health coverage at all. This one is best answered by one of Kevin Drum's commenters, Jesurgislac:
Practically the moment the health system in the US, insofar as it exists, it set up on the basis that your employer will pay for your health insurance. If every employer in the US simply decided that from now on the money they paid to subsidize employee health insurance was to go to their shareholders instead, and people would only have health insurance if they could afford to buy an individual plan, then the US would suddenly face a health care crisis the like of which it's never seen: not just 45 million people without health insurance, but probably more like 250 million. The whole health "system" would crumble into bankruptcy.
Wal Mart's moral obligation to provide health insurance for all its employees arises from the fact that it makes its profits from a system which assumes that all major employers do so. If all major employees imitated its business model, the system would collapse and kill hundreds of thousands.
Yes, exactly. I'd be delighted if we had a system of national health coverage in the U.S., because I've seen firsthand what happens when people fall through the cracks of our existing patchwork system. When the day comes that a national system is put in place, we'll have worked out how much you and I and the Walton family and the Wal-Mart corporation all need to contribute through our taxes to make it happen. Right now, part of Costco's taxes go to cover the government-funded health care provided to Wal-Mart employees, but Wal-Mart's taxes don't go to cover Costco's employees. It amounts to a taxpayer-funded subsidy of Wal-Mart's profits.