(Pix © Larry Catá Backer 2015)
I have been writing for some time on the turn in the basic principles underlying the administration of health benefits at the American public and publicly assisted university. I have been particularly concerned that much of this turn has been driven by quite veiled changes in, and the manipulation of, the core premises within which discussions about benefits are presented--and constrained within relevant stakeholder communities (see esp."First Principles" and Benefits Policies at Public Universities--How "Where You Start" Determines the Shape and "Ends" of Benefit Programs).
That is, when administrators choose to frame the "issue" of benefits as one of "sustainability" and cost containment, the resulting conversation will invariably turn on the means through which the scope and operation of benefits provisions may be legitimately discussed. It turns the human element into an abstraction--and the individuals benefited into factors in the calculation of operating margins--margins that when positive go toward the care of the institutional machinery that itself appears to need constant feeding without regard either to cost cutting or to the constraining language of sustainable operation. Sustainability, it turns out, can mean little more than the conversion of all university outlays into segmented units expected to pay for themselves. It is the language of the balancing of ledgers without regard to ethics or morals.
What is lost when administrators manage university stakeholders into the sort of sterile framework of "sustainability" and cost containment as the only basis in which benefits can be discussed?
We lose, first, the human element, that element that is abstracted when it is reduced to a ledger entry on the books of multi-million (billion) dollar operations. What is left of the individual is also abstracted within the eugenics programs that are now attached to the cost containment and sustainability ideologies that constrict "reasonable" discussion of benefit programs. Protecting the value of the herd for the profit of the farmer has always been good business--not necessarily for the herd but certainly for the farm. And it is only for the aggregated benefit of the farm that the form and substance of eugenics programs are likely to be directed (see here and here).
Consider this human element for the richness that is lost with a framing of benefits discussions as an objective of privatizing and exporting the costs of benefits onto those individuals who are supposed to be benefited from the programs.
I had a mammogram last week. They told me that my insurance did not cover the new 3-d imaging. I would have to pay $65 extra for this imaging - special for a dense breast. I paid the extra $65, and they found something. I went back, and today had a biopsy, I wait 2 days for the result. What if I didn't spend the extra money? No worries for me, what is $65?
What if I worked in another area of the university, where my salary made it difficult to afford the extra $65? Why doesn't our benefits program cover this new technology, that has possibly picked up something in a nascent stage (or hopefully nothing!)?
It occurred to me today as I walked out of the hospital listening to another woman who opted to pay. Good idea I said, as I told her it showed the radiologist something new.
But what about folks, for who $65 means a week of food?
This could be anyone, and the procedures could be about anything. The "cost containment" could affect any form of provision of care. But in the general discussion about aggregate costs and about the aggregate benefits of aggregated benefit plans for the aggregate benefit of the university, perhaps the university understood as the aggregated present value of its long term operations, the aggregated effects on individuals, and especially individuals aggregated by downward pressures on salaries and upward pressures on medical treatment "choices", is certainly marginalized, at best--and for the most part lost in the hosannas of congratulations for the ability to save aggregations of $65. And these are precisely the framing of the discussion that is no longer possible in the modern "sustainable" university.
That is a pity. It is a pity because it is unnecessary, though convenient for some. And the greatest pity is that sustainability can also be understood beyond its segmented self referencing ideal of paying for itself. Sustainability might also reflect to the deployment of university resources, and especially its human resources, in a way that avoids treating human resources as wasting assets, that sustainability might also contain an ethical element. It may go to the ideal of the dignity of work (e.g., here for one view). But these are discussions about sustainability that are foreclosed by the constraints within which benefits discussions are placed.
But these are precisely the kinds of conversations that are foreclosed when the terms of the discussion are limited by the premises within which legitimate discussion is constrained. Might there be an ethics to this constraining approach? Ought tat to be a conversation that is worthy of a discussion among university stakeholders? I suspect that it is (see here).